Trypan Blue-Assisted Vitrectomy

In Brief Purpose: To evaluate the efficacy of trypan blue dye for the staining and removal of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid during pars plana vitrectomy. Methods: The authors retrospectively reviewed a consecutive series of 26 eyes of 26 patients in whom trypan blue 0.15% dye was used to stain intraocular tissues during vitrectomy surgery. Results: The cases reviewed included the following diagnoses: epiretinal membrane (13), macular hole (9), proliferative vitreoretinopathy (2), chronic pseudophakic cystoid macular edema (1), and chronic diabetic macular edema (1). The application of trypan blue resulted in a useful and consistent bluish staining, facilitating the identification, delineation, and removal of the epiretinal membrane, internal limiting membrane, or posterior hyaloid in all patients. Six months after the surgery, visual acuity was better or the same in 21 of the 26 patients. There were no clinical signs of retinal toxicity in any patients. Conclusion: Trypan blue staining of the internal limiting membrane, epiretinal membranes, and the posterior hyaloid is a useful adjunct in vitreoretinal surgery and improves the efficiency and safety of membrane identification and removal. The success of vitrectomy surgery for macular hole and epiretinal membrane depends in large part on the successful identification and removal of epiretinal tissues including internal limiting membrane (ILM), epiretinal membrane (ERM) and posterior hyaloid (PH). While some ERMs may be readily visible to the surgeon, they can at times be subtle with indistinct edges. Similarly ILMs may be challenging to identify and subsequently remove. Difficult removal of these tissues increases risk of iatrogenic damage to the retina, the duration of surgery and the risk of phototoxicity to the retina.