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. 2003 Jun;87(6):713-6.
doi: 10.1136/bjo.87.6.713.

Double vital staining using trypan blue and infracyanine green in macular pucker surgery

P Stalmans  1 , E J Feron, R Parys-Van Ginderdeuren, A Van Lommel, G R J Melles, M Veckeneer
Affiliations

Double vital staining using trypan blue and infracyanine green in macular pucker surgery

P Stalmans et al. Br J Ophthalmol. 2003 Jun.

Abstract

Aims: To study the clinical properties of double vital staining in premacular fibrosis, facilitating complete removal of all epiretinal tissue.

Methods: In a two step surgery, the epiretinal pucker was removed after staining with trypan blue, whereafter the inner limiting membrane was peeled after staining with infracyanine green.

Results: In all 30 patients, a separate epiretinal layer and inner limiting membrane were removed from the macular area. Pathological examination showed different histological properties of the removed layers. An increased visual acuity was measured in 26 patients, and a slightly decreased visual acuity in one patient.

Conclusion: The described double staining technique could be a novel valuable tool that may help to achieve optimal anatomical and functional recovery after surgery for premacular fibrosis

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Figures

Figure 1
Figure 1
Intraoperative view of macular pucker before (A) and after (B) staining with trypan blue.
Figure 2
Figure 2
Intraoperative view of removed macular pucker (A), and after consecutive staining with ICG (B).
Figure 3
Figure 3
Removal of the ILM. (A) Incision of the ILM at the upper arcade using a 19 gauge sclerotomy knife. Note the wrinkling of the ILM. (B) Grasping the edge of the incised ILM with a forceps. (C) Wide angle view after removal of the ILM from the macular area. Note small capillary haemorrhages secondary to traction exerted by the ILM on the retina.
Figure 4
Figure 4
Visual acuity was measured before surgery (axis), and during the last post-operative visit (ordinate). In 26 patients, an increased visual acuity was measured; in three the visual acuity did not change and in one patient a slight decrease in visual acuity was observed. See text for more details.
Figure 5
Figure 5
Electron microscopic image of removed membranes. (A) Tissue removed after staining with trypan blue. Detail of fibrous astrocyte and collagen fibres. (B) Tissue removed after staining with infracyanine green. Detail of ILM (*) and fibrocyte (#). Arrows indicate the margin of the ILM.
See this image and copyright information in PMC

Comment in

References

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    1. Feron EJ, Veckeneer M, Parys-Van Ginderdeuren R, et al. Trypan blue staining of epiretinal membranes in proliferative vitreoretinopathy. Arch Ophthalmol 2002;120:141–4. - PubMed
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    1. Stalmans P, Parys-Vanginderdeuren R, De Vos R, et al. ICG staining of the inner limiting membrane facilitates its removal during surgery for macular holes and puckers. Bull Soc Belge Ophtalmol 2001:21–6. - PubMed

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