Comparative evaluation of anatomical and functional outcomes using brilliant blue G versus triamcinolone assisted ILM peeling in macular hole surgery in Indian population

Abstract

Purpose: To compare anatomical and functional outcomes using brilliant blue G (BBG) vs triamcinolone acetonide (TA)-assisted ILM peeling in macular hole surgery (MHS).

Study design: Simple, comparative, retrospective, non-randomised, interventional single-centre study.

Methods: Ninety-four eyes of 94 patients with idiopathic macular holes (≥ stage 2) who underwent MHS at our centre were included. Patients with failed macular holes, post-traumatic macular holes, history of previous vitreoretinal surgery, high myopia (6 dioptres or more) or any other macular pathology potentially limiting visual acuity, such as diabetic retinopathy or age-related macular degeneration, were excluded. An OCT evaluation of hole status was followed by pars plana vitrectomy for each of these eyes. Those who underwent TA-assisted ILM peeling were considered as group 1 and those with BBG-assisted ILM peeling were considered as group 2. Primary outcome measures included anatomical hole closure and functional success in terms of change in visual acuity of ≥2 LogMAR lines. Various preoperative factors were also evaluated.

Results: Anatomical hole closure was achieved in 85 eyes (90.43%) and visual gain in 78 eyes (82.9%). Mean postoperative follow-up duration was 16.14 ± 1.95 months. No significant difference was found in anatomical and functional success between the two groups. Group 1 had a significantly higher incidence of postoperative glaucoma. Duration of symptoms of <12 months (p = 0.004) and preoperative visual acuity ≤1.0 LogMAR were related to anatomical success. However, greater visual gain was found in patients with chronic holes (≥12 months) (p = 0.046) and poor preoperative visual acuity (>1.0 LogMAR) (p = 0.001).

Conclusion: BBG-assisted ILM peeling offers an effective alternative to triamcinolone, with the added advantage of marked enhancement of vitreoretinal interface contrast with comparable hole closure rates and visual outcomes.