Nederlands Instituut voor Innovatieve Oogheelkundige Chirurgie

	Netherlands Institute for Innovative Ocular Surgery Research and development of ophthalmic surgical techniques
	Laan Op Zuid 390, 3071 AA Rotterdam, The Netherlands tel +31 (0)10 297 4444, fax +31 (0)10 297 4440

Vital dye in posterior segment surgery

Background

Peeling of the internal limiting membrane (ILM) in macular hole surgery, peeling of epiretinal membranes (ERM) in macula Pucker or proliferative vitreoretinopathy are challanging procedures. It may be difficult to distinguish the extend and location of the ILM or ERM, and to remove the tissue without damage to the underlying retina.

To visualize the ILM or the outline of the ERM trypan blue 0.15% may be applied onto the retina. After a liquid-air exchange, filling the vitreous cavity completely, application trypan blue results in immediate staining of the ILM or ERM. Then, after all excess dye is removed under air, an air-liquid change may be performed, and the tissue may be removed using routine surgical techniques..

Product

In 1997, a panel of 45 vital dyes was evaluated by the Netherlands Institute for Innovative Ocular Surgery to stain the ILM and ERM, in order to facilitate the visualization of these tissue structures in vitrectomy surgery. From this series of dyes, trypan blue was chosen, because it was most effective in a relatively low concentration, it was known to show good biocompatibility in mature cataract surgery .

Trypan blue is now produced for intraocular use as 'MembraneBlue' by D.O.R.C. International b.v., Scheijdelveweg 2, 3214 VN Zuidland, Nederland, tel: 31 (0)181 458080, fax: 31 (0)181 458090, e-mail: mailto@dorc.nl.

Surgical technique and Results

After staining the ERM, the membrane is clearly visible and the leading edge of the membrane can be easily visualized during removal, due to the clear contrast between the stained membrane and the unstained underlying retina.

The clinical results of vitreoretinal surgeries with the application of trypan blue may yield the same results as surgeries without the use of the dye. Overall, the surgery may be performed quicker, and more safely since there is less risk of inadvertent retinal damage. Also, more complete removal of the membranes may reduce the risk of recurrent disease, and indirect imp