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pauline lallemand, Claude Speeg-Schatz, Tristan Bourcier, David Gaucher; Systematic use of trypan blue dye in macular pucker surgery: is it worthy?. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2818.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the anatomical and functional outcomes of macular pucker (MP) surgery with and without systematic use of trypan blue dye. The impact of systematic dye-assisted surgery on the surgery duration was also evaluated.
All patients operated on for MP in the university hospital of Strasbourg between january 2009 and Mai 2012 were included in this retrospective study. They all underwent a 23Ga vitrectomy with peeling of the MP. Patients operated on before june 2011 had dye-assisted surgery only when recommanded by the surgeon (group 1). After june 2011, patients had a systematic dye-assisted surgery. Best corrected VA (logMAR) and the central macular thickness (CMT) were measured before surgery, 3 months after surgery and at the end of follow up. The surgeries duration was systematically recorded in both groups.
157 patients (162 eyes) were included. 110 eyes in group 1 and 52 in group 2. There was no difference between the two groups in terms of age and gender, mean Preoperative VA, lens status (phakic or pseudophakic), or vitreous status (posterior vitreous detachment)(p>0.05). MP were either idiopathic (96 eyes, 59.26%) or secondary (66 eyes, 40.74%)(to diabetes, retinal detachment, myopic retinoschisis, uveitis, macular telangiectasia, retinal vein occlusion). The mean 3 months VA (0.336 group 1 and 0.318 group 2) and final VA (0.307 group 1 and 0.282 group 2) did not differ in both groups (p>0.05). The difference between preoperative and postoperative CMT was not statistically different at 3 months (101.1μ group 1 and 99.5μ group 2) and at the end of follow up (102.6μ group 1 and 99.5μ group 2)(p>0.05). Operation duration was significantly reduced in group 2 (46min group 1 versus 35min group 2)(p=0,0038). Sub population study revealed that for secondary MP, postoperative VA and visual gain were better in group 2 (0,282±0.288 and 39.1%) than in group 1 (0.307±0.274 and 33.9%)(p=0,03 and p=0,025 respectively). In this sub population, the reduction of CMT did not differ between the two groups (25.4% group 1 and 26.4% group 2)(p>0.05).
The systematic use of dye for MP surgery reduces operation time. It may also help to reach better visual results in cases of MP secondary to retinal diseases but not in idiopathic ones. Secondary MP may be more complex to operate and benefit from systematic dye-assisted surgery.
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