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A COMPARISON OF BRILLIANT BLUE G, TRYPAN BLUE, AND INDOCYANINE GREEN DYES TO ASSIST INTERNAL LIMITING MEMBRANE PEELING DURING MACULAR HOLE SURGERY

2011; Lippincott Williams & Wilkins; Volume: 31; Issue: 10 Linguagem: Inglês

10.1097/iae.0b013e318213618c

1539-2864

Dhananjay Shukla, Jay Kalliath, Nithya Neelakantan, Kannan B. Naresh, Kim Ramasamy,

Glaucoma and retinal disorders

In Brief Purpose: To compare surgical outcomes with three dyes, brilliant blue G (BBG), trypan blue (TB) and indocyanine green (ICG), used to facilitate internal limiting membrane peeling during macular hole surgery. Methods: This comparative, interventional cases series consisted of 50 eyes of 50 patients with senile idiopathic macular holes, who underwent vitrectomy with internal limiting membrane peeling using BBG (n = 15), TB (n = 20), or ICG (n = 15). The cases involving use of BBG and TB were enrolled prospectively and concurrently, and the cases using ICG were selected through chart reviews. We compared the intraoperative surgical facilitation with the 3 dyes and the surgical outcomes in terms of macular hole closure and visual improvement at 6 months. Results: The 3 groups were similar in mean age, sex distribution, preoperative best-corrected visual acuity, and duration of follow-up (P = 0.957, 0.974, 0.939, and 0.5524, respectively). Of the 3 dyes, BBG appeared to provide greatest intraoperative facilitation: most convenient to use and remove, and similar to ICG in terms of internal limiting membrane staining. Six months postoperatively, macular hole closed in 100%, 95%, and 86% eyes (P = 0.48) and visual improvement occurred in 80%, 85%, and 33% eyes (P = 0.005) in BBG, TB, and ICG groups, respectively. The BBG and TB groups also had a better final best-corrected visual acuity than ICG group (P = 0.05) and smaller percentage of visual decline (5% and 6.7% vs. 40% respectively; P = 0.049). Conclusion: Brilliant blue G was comparable with TB in optimizing visual and functional outcomes, while it was similar to ICG in ease of internal limiting membrane peeling. This comparative study tested the two most commonly used dyes, trypan blue and indocyanine green, against a recently introduced dye, brilliant blue G, to assist internal limiting membrane peeling in macular hole surgery: the dyes were compared in the facility of intraoperative usage and postoperative visual and anatomical outcomes. While comparable anatomical outcomes were obtained with all three dyes, trypan blue and brilliant blue G were superior to indocyanine green in visual gains. Brilliant blue G appeared to combine the best features of the other two dyes in terms of ease of use and optimizing surgical outcomes.