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C. Veronese, M. Morara, F. Pichi, C. Torrazza, F. Borri, T. Perossini, A. Ciardella; Photoxicity Associated to the Use of Brilliant Blue G in Vitreoretinal Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2554.
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© ARVO (1962-2015); The Authors (2016-present)
To describe two cases of retinal phototoxicity on the outer retina and retinal pigment epithelium (RPE) after BBG assisted Internal Limiting Membrane (ILM) peeling for Macular Hole (MH).
Observational case series. Two patients who had developed phototoxic retinal damage after 25 G vitrectomy with BBG assisted ILM peeling were followed for 1 year. All patients underwent a complete clinical examination including measurement of best corrected visual acuity (BCVA), fundus autofluorescence (FAF) and optical coherence tomography (OCT). Patients were seen 1 day before surgery and then 1 week, 1 month and 1 year after surgery. The surgery consisted of the standard 3 port 25 G pars plana vitrectomy, air-fluid exchange injection of 0.2 ml of BBG (Brilliant Peel-Fluoron). The BBG was left to stain the ILM for 2 minutes. Fluid-air exchange, aspiration of the BBG with a flute needle, and peeling of the ILM were then performed. Sulfur exafluoride (SF6) at concentration 20% was used as a tamponade.
The MH closed in both cases. BCVA of patient 1improved from 20/200 to 20/20 and of patient 2 from 20/100 to 20/60. FAF showed scattered hyperautofluorescent spots with a characteristic ring distribution around the fovea. OCT demonstrated a deposition of material, possibly lipofuscin, between the cells of the retinal pigment epithelium and Bruch’s membrane. In patient 1 such changes reduced in size with time and at the 1 year follow-up visit were almost resolved. In patient 2 unfortunately the spots coalesced to form a large area of RPE atrophy temporary to the fovea. Such changes were interpreted as a result of a phototoxic outer retinal damage.
These 2 patients presented with outer retinal phototoxic damage after uncomplicated macular surgery. We think that our technique for staining the ILM caused an excessive concentration of BBG in the ILM which was responsible of the phototoxic damage. Since then we have changed our staining technique, we inject 0.2 ml of BBG in a fluid-filled eye and we remove it after 30 seconds. We have not noted anymore phototoxic damage.
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