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Rodrigo Lechuga, Hugo Sepulveda, Gerardo Garcia-Aguirre, Juan Manuel Jimenez-Sierra, Daniel Ochoa-Contreras, Virgilio Morales-Canton; Double Staining Technique With Brilliant Blue G and effect on ganglion cells for Macular Pathology. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1158.
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To describe the double staining with the vital dye brilliant blue G (BBG) like a useful technique for identifying and peeling the internal limiting membrane (ILM) during vitrectomy in eyes with macular hole (MH) or epiretinal membrane (ERM) and evaluate the safety and the effect of BBG on ganglion cells.
Prospective, clinical trial. We apply Double Staining Technique with BBG (ILM-Blue, DORC International) on concentration of 0.025% (0.5ml syringe, 0.125 mg) in patients vitrectomized for MH or ERM. Imaging was performed preop¬eratively and 1 month postoperatively using spectral-domain optical coherence tomography (SD-OCT; Cirrus HD-OCT, Carl Zeiss Meditec) with software that allows anatomic analysis of the ganglion cell layer and the inner plexiform layer. For functional analysis of ganglion cells, pat¬tern reversal ERG testing, specific for measuring the function of the ganglion cells, was performed preoperatively and 1 month postoperatively. Multifocal ERG (mERG) was also performed at the same intervals to measure the function of the macula.
24 eyes from 22 patients were evaluated, with a mean age of 71 years. Diagnosis of MH corresponded to 62.5% (n=15), and ERM to 37.5% (n=9). 16 were feminine and 6 masculine. In 79% (19/24) cataract surgery with intraocular lens implantation was performed during vitrectomy. The preoperative mean macular thickness of ganglionar cell layer to intern plexifom layer (GCL + IPL) was 46.3 microns and 50.4 microns postoperative with p=0.43 (t test) and p=0.20 (Wilcoxon). Pat¬tern reversal ERG testing showed mean preoperative N35-P50 value of 4.79 uV and 4.94 uV postoperative with p=0.73 (t test) and p=0.66 (Wilcoxon). Preoperative P50-N95 value of 7.57 uV and 7.41 uV postoperative with p=0.78 (t test) and p= 0.20 (Wilcoxon). mERG did not showed statistically significant difference in the 5 central rings; ring 1 p=0.51, ring 2 p=0.57, ring 3 p=0.23, ring 4 p=0.23 and ring 5 p=0.15.
Double staining tecnique with BBG has proven useful in the remotion of membranes over the retinal surface, specially in cases of ERM. The use of BBG dye as adyuvant in MH and ERM surgery did not showed significant alterations in the thickness of the ganglionar cell layer or in its function evaluated with pattern reversal ERG. In the same way, we didn`t found statistically significant difference in the macular function evaluated with mERG.
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