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LUTEIN: A New Dye for Chromovitrectomy

Maia, Mauricio MD, PhD; Furlani, Bruno A. MD; Souza-Lima, Acácio A. PhD; Martins, Diogo S. PhD; Navarro, Rodrigo M. MD; Belfort, Rubens Jr MD, PhD

doi: 10.1097/IAE.0b013e3182a0b7f4
Original Study

Purpose: To evaluate the feasibility, advantages, and safety of a novel lutein-based dye for improving identification and removal of the vitreous, internal limiting membrane, and epiretinal membrane during chromovitrectomy in humans.

Methods: We prospectively evaluated 12 eyes that underwent pars plana vitrectomy using the dye in patients with macular hole, epiretinal membrane, or proliferative diabetic retinopathy/tractional diabetic macular edema. One surgeon performed standard chromovitrectomy and completed a postoperative questionnaire to compare the staining with that of the available dyes. The peeled membranes were evaluated histologically. Follow-up examinations were performed on postoperative Days 1, 7, 30, 90 and 180; best-corrected visual acuity, optical coherence tomography, fluorescein angiography, autofluorescence, and visual fields were performed.

Results: The green dye was deposited on the posterior pole because of its higher density than balanced saline solution; vigorous dye flushing into the vitreous cavity was unnecessary. The dye stained the posterior hyaloid/vitreous base by deposition onto the vitreous; brilliant blue stained the internal limiting membrane. The epiretinal membrane was poorly stained. The best-corrected visual acuity improved in all eyes without clinical toxicity or toxicity on images/visual fields. Histology showed effective removal of the internal limiting membrane and epiretinal membrane in all eyes.

Conclusion: The new dye improved intraoperative identification of the internal limiting membrane and the posterior hyaloid/vitreous base during chromovitrectomy.

Supplemental Digital Content is Available in the Text.A new dye for vitreoretinal surgery that comprises lutein and zeaxanthin crystals 0.3% and brilliant blue 0.025% is advantageous compared with other dyes currently used for chromovitrectomy and showed no signs of toxicity at 6 months of follow-up.

Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.

Reprint requests: Mauricio Maia, MD, PhD, Department of Ophthalmology, Vitreoretinal Surgery Unit, Federal University of São Paulo, Rua Botucatu 822, São Paulo 06023-062, Brazil and Brazilian Institute of Fighting Against Blindness, Assis and Presidente Prudente, Sao Paulo, Brazil; e-mail: retina@femanet.com.br

None of the authors have any financial/conflicting interests to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.retinajournal.com).

Proprietary interest: The use of the combination of lutein/zeaxanthin and brilliant blue in human eyes is proprietary with a patent pending (Publications US 20120251458 and WO 2012135432).

© 2014 by Ophthalmic Communications Society, Inc.