Staining Of The Internal Limiting Membrane With A Novel Heavy Brilliant Blue G-solution

Abstract

Purpose: : To investigate the hydrodynamic properties, clinical efficacy and safety of a novel heavier-than-water dye (BBG-D₂O) designed for staining of the internal limiting membrane (ILM) during vitreoretinal procedures, consisting of brilliant blue G (BBG, 0.25 mg/ml) with the addition of 13 % of deuterium oxide (D₂O).

Methods: : The gravity related hydrodynamic distribution of BBG-D₂O was analysed in 7 experiments using standard test cuvettes filled with balanced salt solution (BSS) and compared to conventional BBG. Clinically BBG-D₂O was used in 15 patients (mean age: 74.4 +/- 5.1 years) with epiretinal membranes (ERM)) for staining of the ILM during surgery. Removed ERM and ILM were processed for light microscopic analysis.

Results: : Compared to standard solutions of BBG the heavy preparation of the dye (BBG-D₂O) presented a rapid flow towards the bottom of test cuvettes. After 15 seconds the concentration of BBG in the lowest 25 % of the cuvettes was 4.2 +/- 0.2 µg/ml (mean +/- standard deviation) compared to 19.0 +/- 2.6 µg/ml of BBG-D₂O (p<0.005). Clinically BBG-D₂O resulted in a strong staining effect of the ILM, comparable to conventional indocyanine green (ICG) solution and clearly more intensive than that of conventional BBG solution of the same concentration (0.25 mg/ml). The intensive staining effect of primary applied BBG-D₂O (before ERM removal) allowed in the majority of cases (10 of 15) an en bloc removal of ILM and ERM together as a one-step procedure. Removal of the ILM was histopathologically confirmed in all cases. No signs of adverse effects related to the use of BBG-D₂O were observed during a follow-up period of at least 2 months.

Conclusions: : Heavy brilliant blue G (BBG-D₂O ) provides a significantly improved staining effect of the ILM and by this makes ILM peeling more efficient and easier.

Keywords: macula/fovea • vitreoretinal surgery • retina