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POSTERIOR HYALOID DETACHMENT AND INTERNAL LIMITING MEMBRANE PEELING ASSISTED BY ANTHOCYANINS FROM ACAI FRUIT (EUTERPE OLERACEA) AND 10 OTHER NATURAL VITAL DYES: Experimental Study in Cadaveric Eyes

Chen, Jane MD*; Ferreira, Magno Antonio MD*,†; Farah, Michel Eid MD, PhD*; de Carvalho, André Maia MD*; Alves Ferreira, Raquel Eustaquio MD; de Moraes Filho, Milton Nunes MD*; Souza Lima-Filho, Acácio Alves PhD; Lago, João Henrique G. PhD§; Sartorelli, Patricia PhD§; Rodrigues, Eduardo Buchele MD*; Ferreira, Eber PhD; Peris, Cristiane PhD*; Maia, Maurício MD, PhD*

doi: 10.1097/IAE.0b013e3182618a6d
Original Study
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Purpose: The purpose of this study was to determine whether natural dyes facilitate posterior hyaloid detachment (posterior vitreous detachment [PVD]) and retinal internal limiting membrane (ILM) peeling in human eyes.

Methods: Open-sky vitrectomy with posterior hyaloid and ILM removal was performed in 86 human cadaveric eyes. After core vitrectomy, 11 different dyes were injected into the vitreous cavity to aid hyaloid detachment and ILM removal. The dyes were allowed to settle on the macula for 5 minutes after PVD and were removed by mechanical aspiration. Intraocular forceps were used for ILM peeling, which was confirmed by light microscopy of the peeled tissue. Acai fruit (Euterpe oleracea) extract and 10 additional dyes from plants or animal sources were tested: pomegranate (Punica granatum), logwood (Haematoxylum campechianum), chlorophyll extract from alfalfa (Medicago sativa), cochineal (Dactylopius coccus), hibiscus (Hibiscus rosa-sinensis), indigo (Indigofera tinctoria), paprika (Capiscum annuum), turmeric (Curcuma longa), old fustic (Maclura tinctoria), and grape (Vitis vinifera).

Results: The dyes facilitated PVD and ILM peeling. Acai fruit (E. oleracea) extract, logwood (H. campechianum), cochineal (D. coccus), and old fustic (M. tinctoria) facilitated PVD in all cases; dye-assisted PVD was compared with triamcinolone-assisted PVD performed previously in a comparative model. Acai fruit (E. oleracea) extract, cochineal (D. coccus), and chlorophyll extract from alfalfa (M. sativa) showed the best capability for ILM staining; dye-assisted ILM removal was compared with the ILM peeling guided by indocyanine green staining performed previously in a comparative model. Light microscopy confirmed the ILM removal in all cases.

Conclusion: Anthocyanin dye of the acai fruit (E. oleracea) and the dyes from cochineal (D. coccus) and chlorophyll extract from alfalfa (M. sativa) resulted in the best capability for posterior hyaloid and ILM staining in human cadaveric eyes and may be a useful tool for vitreoretinal surgery.

Certain natural dyes stained the posterior hyaloid and internal limiting membrane in cadaveric eyes and may be useful for tissue visualization during vitreoretinal surgery.

*Department of Ophthalmology, Vision Institute (IPEPO), Paulista School of Medicine, Federal University of Sao Paulo, Department of Ophthalmology, São Paulo, Brazil

Federal University of Uberlandia, Department of Ophthalmology, Uberlandia, Minas Gerais, Brazil

Ophthalmos, Sao Paulo, Brazil

§Institute of Environmental Science, Chemistry and Pharmacy, Federal University of Sao Paulo, Sao Paulo, Brazil

Ethno, Sao Paulo, Brazil.

Reprint requests: Magno Antonio Ferreira, MD, Department of Ophthalmology, Vitreoretinal Surgery Unit, Universidade Federal de Uberlândia, 855, Av Marcos de Freitas Costa, Uberlândia-MG 38400-328, Brazil; e-mail: drmagno@holhosudi.com.br

The first two authors contributed equally to this study. J. Chen led the study with acai fruit extract, and M. A. Ferreira led the study with 10 natural vital dyes.

The authors have no financial or conflicts of interest to disclose.

© The Ophthalmic Communications Society, Inc.