Endoilluminator phototoxic maculopathy associated with combined ICG-assisted epiretinal membrane and internal limiting membrane peeling

Yonekawa, Yoshihiro; Abbey, Ashkan M.; Shah, Ankoor; Thomas, Benjamin; Capone, Antonio

doi:10.2147/opth.s75592

Cited by 16 publications

(13 citation statements)

References 22 publications

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“…A variety of dyes, including trypan blue, indocyanine green (ICG) and BB, are used to dye the ILM (39). Though ICG was first used to peel the ILM in macular surgery, potential side effects have been reported (40). In the present study, BB, a relatively new type of dye, was used to dye the ILM.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study

2019

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The aim of the present study was to investigate whether internal limiting membrane (ILM) peeling in patients with myopic foveoschisis (MF) treated with 23-gauge (23G) vitrectomy improved the anatomical and visual outcomes. In this retrospective cohort study, from March 2014 to August 2017 at the Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University (Nanchang, China), 60 patients (60 eyes) with MF underwent 23G vitrectomy. The patients were grouped according to whether they underwent brilliant blue-assisted ILM peeling (peeling group) or not (non-peeling group). Best-corrected visual acuity (BCVA) and central macular thickness (CMT) on optical coherence tomography were measured. There were 30 eyes in each group and the baseline characteristics were similar (all P>0.05). BCVA improved in 24 eyes (80%) in the peeling group and 25 eyes (83.3%) in the non-peeling group (P=0.922). Preoperative CMT was not significantly different between the peeling and non-peeling group (458±62.2 vs. 460±61.1 µm, respectively, P=0.229). However, postoperative CMT was significantly different between the peeling and non-peeling group (269.3±67.7 vs. 294.4±60.5 µm, respectively; P=0.015). In the peeling group, MF was completely resolved in all 30 eyes, but only in 26 eyes in the non-peeling group (P=0.038). Postoperative Amsler testing was positive in five eyes in the peeling group and 13 eyes in the non-peeling group (P=0.024). Complications were similar in both groups; postoperatively, there were one and two cases of iatrogenic peripheral retinal break, three and two cases of macular hole, and one and one case of retinal detachment in the peeling and non-peeling groups, respectively.23G vitrectomy combined with brilliant blue-assisted ILM peeling resulted in better visual and anatomical effects compared with 23G vitrectomy alone in patients with MF.

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Section: Discussionmentioning

confidence: 99%

Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study

2019

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“…In addition, vital dyes can prompt photochemical retinal injury by increasing levels of free radicals, as an overlap of absorbance spectrum facilitates the absorbance light by the retina stained with dye, especially with the use of ICG. 15 For other dyes (including BBG), a reduction in cell viability has been reported with the use of visible light endoilluminator. 14…”

Section: Discussionmentioning

confidence: 99%

Osmolarity and spectrophotometric property of brilliant blue green define the degree of toxicity on retinal pigment epithelial cells exposed to surgical endoilluminator

Balaiya¹,

Saurabh²,

Cook³

et al. 2016

OPTH

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ObjectiveTo evaluate the effect of varying concentrations of brilliant blue green (BBG) and their different biochemical characteristics on retinal pigment epithelial (RPE) cells under xenon light source illumination at varying distances to identify safe parameters for intraoperative use.MethodsHuman retinal RPE cells (ARPE-19) were exposed to two concentrations (0.25 and 0.50 mg/mL) of BBG and illuminated with a xenon surgical illuminator at varying distances (10 and 25 mm), intensity levels, and time intervals (1, 5, and 15 minutes). Additionally, the effect of osmolarity was examined by diluting BBG in different concentrations of glucose. Cytotoxicity of BBG and osmolarity effects on cell viability were evaluated using a WST-1 assay. Light absorption and emission characteristic of BBG in different solvents were measured using a plate reader at different wavelengths. Lastly, the activity of caspase-3 was also studied.ResultsCell viability of ARPE-19 cells was 77.4%±12.7%, 78.7%±17.0%, and 65.0%±19.7% at 1, 5, and 15 minutes to exposure of high illumination xenon light at 10 mm (P<0.05) compared to controls. At both distances of illumination (10 and 25 mm), similar cell viabilities were seen between 1 and 5 minutes of exposure. However, there was a decline in viability when the illumination was carried out to 15 minutes in all groups (P<0.05). There was no significant reduction in cell viability in presence or absence of xenon light in different osmolar solutions concentrations of glucose (P>0.05). Maximal light absorption of BBG was noted between 540 and 680 nm. Activated caspase-3 level was not significant in both the concentrations of BBG (P>0.05).ConclusionOur findings suggest that BBG at 0.25 mg/mL during vitreoretinal surgery is safe and not toxic to RPE cells up to 5 minutes under focal high illumination (10 mm) and up to 15 minutes under medium diffuse illumination (25 mm). BBG was safe to be mixed with isotonic glucose solution at the concentration range of 2.5%–10%, regardless of the illumination status.

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“…Finally, there are theoretical concerns that ICG staining may result in potential toxicity to the retina. 47,48 Although it is unclear what the exact mechanism of ICG toxicity is, it is thought that the ICG may damage the underlying retina and retina pigment epithelium (RPE) by migrating into the subretinal space [49][50][51][52] and potentially leading to visual field defects. [53][54][55] In support of this observation, experimental studies have demonstrated that there are ICG-induced, dose-dependent morphologic and functional changes in the retina and retinal pigment epithelium.…”

Section: Cons Of Ilm Peelingmentioning

confidence: 99%

Internal Limiting Membrane Peeling During Idiopathic Epiretinal Membrane Removal

Roh

Kim

Eliott

et al. 2017

Journal of VitreoRetinal Diseases

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Endoilluminator phototoxic maculopathy associated with combined ICG-assisted epiretinal membrane and internal limiting membrane peeling

Cited by 16 publications

References 22 publications

Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study

Outcomes of 23G vitrectomy and internal limiting membrane peeling with brilliant blue in patients with myopic foveoschisis from a retrospective cohort study

Osmolarity and spectrophotometric property of brilliant blue green define the degree of toxicity on retinal pigment epithelial cells exposed to surgical endoilluminator

Internal Limiting Membrane Peeling During Idiopathic Epiretinal Membrane Removal

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