Trypan blue staining of internal limiting membrane and epiretinal membrane during vitrectomy: visual results and histopathological findings

Abstract

Aims: To report on the use of trypan blue (TB) 0.06% for staining the internal limiting membrane (ILM) and epiretinal membrane (ERM) during vitrectomy and report on their histology. Method: 14 consecutive patients with idiopathic macular hole or macular pucker (seven patients each) were prospectively recruited for ILM or ERM peel respectively. After pars plana vitrectomy and induction of posterior vitreous detachment, 0.5 ml TB 0.06% in phosphate buffered saline (VisonBlue) was injected over the posterior pole in an air filled eye and left for 2 minutes. The stained tissue was peeled with intraocular forceps. Specimens were evaluated using histochemical and immunohistochemical methods. Results: The average follow up was 4.4 months. Internal limiting membranes and epiretinal membranes were stained satisfactorily in all cases and removed successfully. Eight patients (57%) had improvement of 2 or more Snellen lines. All seven macular holes closed. In the ERM cases, no residual membranes were observed clinically, at the latest follow up. No complications relating to the use of the dye were encountered intraoperatively or postoperatively. Of the 14 procedures, nine (four macular hole and five macular pucker) yielded sufficient tissue for histopathological evaluation. Histological and immunohistological assessment revealed that the morphology of these specimens was similar to that observed in macular hole ILM and macular pucker ERM removed without the aid of dye. Conclusion: TB staining facilitated the identification and delineation of ILM and ERM removal during the surgical management of macular holes and macular pucker. The visual outcome of this series and the specimens removed suggest they are no different from those without TB staining. Its use in posterior segment appears to be safe but further studies are required to investigate its long term safety.

A rationale for membrane peeling in the repair of stage 4 macular holes

“…Histologically, the appearances of the ERM peeled were comparable to specimens removed in other studies. 16,17 The ERM specimens also showed resemblance in their histological and immunocytochemical characteristics with PHM specimens obtained in a previous study. 7,18 They both contain type IV collagen and GFAP-positive cells.…”

Iatrogenic macula hole and consequent macular detachment caused by intravitreal trypan blue injection

“…No peroperative or postoperative complications were described. 1,3 Follow-up after 3-4 months showed visual outcomes comparable to those without staining and did not reveal any adverse reactions related to dye use. 1,3 However, there are no studies regarding the effects of trypan blue in the longer term as yet.…”

“…Imatinib mesylate (Gleevec; Novartis Pharmaceuticals, East Hanover, NJ, USA) is a selective inhibitor of the bcr-abl, c-kit, and platelet-derived growth factor receptor tryrosine kinases and is a promising new targeted therapy for patients with chronic myelogenous leukaemia and gastrointestinal stromal tumours. [1][2][3][4][5] Imatinib mesylate is generally well tolerated, with frequent but mild side effects. Reported side effects include myalgia, fatigue, nausea, dyspepsia, diarrhoea, oedema, and liver-function abnormalities.…”

“…Reported side effects include myalgia, fatigue, nausea, dyspepsia, diarrhoea, oedema, and liver-function abnormalities. 1 Approximately 70% of patients with chronic myelogenous leukaemia who receive imatinib mesylate develop mild to moderate regional fluid retention, usually limited to the periorbital region or legs. Rarely, fluid retention can be more generalized, with pleural or pericardial effusions, ascites, and anasarca.…”

Trypan blue-associated retinal toxicity post complicated cataract surgery

“…( In this case of post-traumatic cataract with subluxation, the dye was noted to enter the vitreous cavity through clinically evident and nonevident areas of zonular loss. Although Trypan blue at a concentration of 0.06% with exposure time of 2 min has not been found to cause retinal toxicity, [3][4][5] prolonged dye exposure has been reported to be toxic to the retina. In this case, the dye remained in the vitreous for 4 days thereby resulting in toxicity.…”