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Andre M. Gomes, Thais S. Mendes, Osias F. de Souza, Kelcia Kiefer, Carolina R. D'Andrea, Michele M. Freitag; Brilliant Blue Toxicity After Internal Limiting Membrane (ILM) Peeling. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2636.
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To evaluate the toxicity of brilliant blue G at 0.5mg/ml as an additive for internal limiting membrane removal and report the RPE structural changes.
30 patients underwent 3 port 23 gauge pars plana vitrectomy with Internal Limiting Membrane (ILM) peeling for Idiopathic Macular Hole (IMH) using brilliant blue G (BBG) staining. The injection of 0.2 ml BBG was performed under Balanced Salt Solution (BSS) and removed after 30 seconds. All patients where postoperatively monitored with Fluorescein Angiography (FA) and Spectral Domain Optical Coherence Tomography (SD-OCT) to evaluate the RPE changes in the macula.
Macular hole closure was achieved in 100% of the patients and the postoperative best corrected visual acuity (BCVA) improved in 76,7% of the patients. After 12-month follow up, four patients (13%) had significantly persistent RPE changes. FA showed pigmentary changes and RPE atrophy at the macula region.
Brilliant Blue is a helpful tool to improve visualization of the ILM during macular hole surgery and it is reported to be less toxic as compared to other dyes. However it may cause RPE injury. The use of less illumination, lower doses and retinal short-time exposure to BBG during surgery may minimize the risks.
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