Novel ‘heavy’ dyes for retinal membrane staining during macular surgery: multicenter clinical assessment

Abstract

ABSTRACT.Purpose: To evaluate the feasibility of two novel 'heavy' dye solutions for staining the internal limiting membrane (ILM) and epiretinal membranes (ERMs), without the need for a prior fluid-air exchange, during macular surgery. Methods: In this prospective nonrandomized multicenter cohort study, the high molecular weight dyes ILM-BlueÔ [0.025% brilliant blue G, 4% polyethylene glycol (PEG)] and MembraneBlue-DualÔ (0.15% trypan blue, 0.025% brilliant blue G, 4% PEG) were randomly used in vitrectomy surgeries for macular disease in 127 eyes of 127 patients. Dye enhanced membrane visualization of the ILM and ERMs, 'ease of membrane peeling', visually detectable perioperative retinal damage, postoperative best-corrected visual acuity (BCVA), dye remnants and other unexpected clinical events were documented by 21 surgeons. Results: All surgeries were uneventful, and a clear bluish staining, facilitating the identification, delineation and removal of the ILM and ERMs, was reported in all but five cases. None of the surgeries required a fluid-air exchange to assist the dye application. BCVA at 1 month after surgery improved in 83% of the eyes in the MembraneBlue-DualÔ group and in 88% in the ILM-BlueÔ group. No dye remnants were detected by ophthalmoscopy, and no retinal adverse effects related to the surgery or use of the dyes were observed. Conclusion: The 'heavy' dye solutions ILM-BlueÔ and MembraneBlue-DualÔ can be injected into a fluid-filled vitreous cavity and may facilitate staining and removal of the ILM and ⁄ or ERMs in macular surgery without an additional fluid-air exchange.

Electron Microscopic Changes of Rabbit Retina after Chromovitrectomy Using Combined Dyes (Experimental Study)

“…В некоторых нейронах вну-треннего ядерного слоя выявлялись вакуолизированные митохондрии, но большая часть нейронов имела типич-ную для них ультраструктуру (рис. 7,8). В цитоплазме определялись органеллы без каких-либо изменений.…”

“…Проведение хромовитрэктомии направлено на получение максимальной визуальной 1 идентификации удаляемых структур при использовании минимальной нетоксичной концентрации и объема ис-пользуемого красителя 1 [5,6]. Методика хромовитрэктомии применяется доста-точно широко и в последние 10 лет стала стандартной процедурой для большинства витреоретинальных хи-рургов [7].…”

“…Комбинированные красители на основе Trypan blue (TB) и Brilliant blue G (BBG) относятся к новому поко-лению интравитреальных красителей, которые обеспе-чивают достаточно высокую степень окрашивания как внутренней пограничной мембраны, так и эпиретиналь-ных мембран при минимальной концентрации и объеме [1,[7][8][9]. В то же время дискуссионным остается вопрос возможного токсического действия красителей на раз-личные структуры сетчатки [10].…”

Dyes for Eyes™: Hydrodynamics, Biocompatibility and Efficacy of ‘Heavy' (Dual) Dyes for Chromovitrectomy

“…To get a better impression about the clinical efficacy of this dye, a prospective, multicenter cohort study was set up where patients underwent macular surgery using MembraneBlue-Dual injected into a fluid-filled vitreous cavity (63 eyes, 35 male and 28 female, mean patient age 68 ±1.3 years; table 1) [67]. To test whether tissue visualization and ease of membrane peeling are improved by staining both the ILM and ERM simultaneously, instead of sequential ERM removal with ILM peeling alone [68,69], the clinical efficacy of MembraneBlue-Dual was compared to ILM-Blue™ (DORC International), a solution that contains only 0.025% BBG + 4% PEG and thus only stains the ILM (64 eyes, 35 male and 29 female, mean age 68 ±1.3 years; table 1).…”

“…All surgeries were uneventful, and a clear bluish staining supported the visualization and removal of the membranes in >96% of the surgeries, which in 30-40% of cases required a second dye application to improve staining [67]. In 5 cases (4%), all operated on by the same surgeon, the staining effect obtained was found to be insufficient, and ICG was used as a backup stain.…”