Outcome of Macular Hole Surgery using Two Different Dyes, Trypan Blue and Brilliant Blue, for ILM Staining.

Cyrus Shroff

Objective: Outcome of Macular Hole Surgery using Two Different Dyes, Trypan Blue and Brilliant Blue, for ILM Staining.

Purpose: To study the anatomical and functional outcome of macular hole surgery using two different dyes to stain the ILM.

Method: Retrospective non-randomized comparative analysis between study group (Brilliant Blue) and control group (Trypan Blue). 80 patients of idiopathic macular hole who underwent surgery from 2008 to September 2010 were included. Pre- and post-operative best-corrected visual acuity, lens status and Optical Coherence Tomography were done for all patients. 80 patients underwent vitrectomy and ILM peeling. Cataract surgery was combined in 29 cases. 66 patients underwent ILM staining with Trypan Blue (TB), and 14 patients with Brilliant Blue (BB). Tamponade was given in all eyes with C3F8 (65) or SF6 (7).

Results: Mean pre and post operative logMAR best corrected visual acuity (BCVA) was 0.87±0.38 and 0.38±0.30 in the TB group (p<.001) respectively, and 0.68±0.29 and 0.38±0.21 in the BB group (p<.001). Post operatively 64 eyes (97%) in the TB group and 14 eyes (100%) had BCVA ≥ 20/200 (p = .679), 36 eyes (54.5%) in the TB group and 6 eyes (42.9%) in the BB group achieved BCVA ≥ 20/40 (p = .063). 77 of 80 (96.3%) macular holes closed while 3 (3.8%) remained open. No patient had post operative retinal detachment.

Conclusion: There was no statistical difference in the functional outcome between the two groups. However, Brilliant Blue stains ILM better facilitating complete and less traumatic removal. Moreover, in the Brilliant Blue group the absence of fluid-air exchange during staining reduced the chances of lenticular haze during surgery.