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.
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: firstname.lastname@example.org
None of the authors have any financial/conflicting interests to disclose.
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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).