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H. Gerding, M. Timmermann, U. Thelen; Staining of the ILM With Brilliant Blue G (Brilliant Peel®): Safety and Efficacy. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2552.
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To analyze the safety and efficacy of intraoperative staining of the ILM with Brilliant Blue G in patients with macular retinal diseases.
The intraoperative staining effect and complications associated with the application of Brilliant Blue G were documented as digital videao data files and in a standardized intra- and postoperative protocol. Removed epiretinal tissue was collected for histological analysis. All patients were postoperatively monitored at least monthly for the first three months, at 6, and 12 months postoperatively.
131 patients were included in the study. Median age was 71 years (mean 69 +/- 11, range: 15-87). Main basic diseases were: macular pucker: 91 (69 %), macular hole 26 (20 %), diabetic retinopathy 10 (8 %), and uveitis 4 (3 %). Median follow-up was 17 months (mean: 16 +/- 6 months, range 5 to 27). Intraoperative staining was negative for all epiretinal membranes excised. The ILM stained regularly in exposed areas not being covered by epiretinal membranes. ILM after removal of epiretinal membrane layers stained identical to primarily membrane-free areas. The staining effect was much less intensive than that of ICG. In 7 patients severe dye-related complications were observed. 3 of the 10 diabetic patients presented a severe fibrinogenous posterior segment uveitis during the first postoperative week. In 4 patients subretinal deposition of Briliant Blue G occurred. In 3 of them this was a consequence of improper function of the ready to use syringes provided by the manufacturer leading to a jet stream effect of dye which penetrated the retina and was filling the subretinal space. In the fourth case dye reached the subretinal space via a macular hole. Though immediate subretinal irrigation was performed to remove the dye, 3 of these 4 eyes developed a local pigmentary retinopathy and local photoreceptor degeneration.
Brilliant Blue G provides a weak but sufficient staining of the ILM. Staining of epiretinal membranes was negative. There seems to be an increased risk of fibrinogenous uveitis in patients with diabetic retinopathy. Subretinal deposition of Brilliant blue G should be avoided since this may lead to toxic photoreceptor degeneration.
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