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Carpentier, Cristian MD*; Zanolli, Mario MD*; Wu, Lihteh MD; Sepulveda, Gonzalo MD*; Berrocal, Maria H. MD; Saravia, Mario MD§; Diaz-Llopis, Manuel MD; Gallego-Pinazo, Roberto MD; Filsecker, Luis MD*; Verdaguer-Diaz, Juan I. MD*; Milan-Navarro, Rodrigo MD**; Arevalo, J. Fernando MD, FACS††,‡‡; Maia, Mauricio MD**,§§

doi: 10.1097/IAE.0b013e31828e69c2
Original Study

Purpose: To determine the degree of residual internal limiting membrane (ILM) after idiopathic epiretinal membrane (ERM) peeling and the usefulness of staining with brilliant blue G.

Methods: A prospective, multicenter, observational study of 98 eyes undergoing pars plana vitrectomy and membrane peeling for idiopathic ERM. All eyes underwent core vitrectomy (20, 23, or 25 gauge) followed by intravitreal triamcinolone to verify that the posterior hyaloid had been removed. Brilliant blue G (0.2 mL of 0.25 mg/mL) was injected into the vitreous cavity and washed out immediately. The ERM was peeled and then the surgeon observed and recorded the characteristics of the underlying ILM. The posterior pole was restained with brilliant blue G (0.2 mL of 0.25 mg/mL), and the same observations on the characteristics of the ILM were recorded. Peeling of the remaining ILM was performed. The main outcome measured was the status of the ILM after ERM peel. Secondary outcomes included best-corrected visual acuity and central macular thickness at 6 months postoperatively.

Results: After ERM peel, all of the eyes had residual ILM. In 74 eyes, the ILM was present and damaged, whereas in 24 eyes, the ILM was present and undamaged. In 37 eyes, the operating surgeon was unable to determine the status of the ILM before brilliant blue G staining. At 6 months, the logarithm of the minimum angle of resolution best-corrected visual acuity improved from 0.75 ± 0.39 at baseline to 0.31 ± 0.26 (P < 0.0001). The central macular thickness also improved from 460 ± 91 μm at baseline to 297 ± 102 μm (P < 0.003).

Conclusion: Internal limiting membrane is frequently still present after ERM peeling. Staining with brilliant blue G facilitates its identification.

Internal limiting membrane is frequently still present after epiretinal membrane peeling. Staining with brilliant blue G facilitates its identification.

*Fundación Oftalmológica Los Andes, Santiago, Chile;

Instituto de Cirugía Ocular, San José, Costa Rica;

Department of Ophthalmology, University of Puerto Rico, San Juan, Puerto Rico;

§Department of Ophthalmology, Universidad Austral, Buenos Aires, Argentina;

Instituto Oftalmológico de Valencia, Valencia, Spain;

**Vitreoretinal Surgery Unit, Brazilian Institute of Fighting Against Blindness, Assis/Presidente Prudente, Sao Paulo, Brazil;

††The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia;

‡‡Wilmer Eye Institute, The Johns Hopkins University, Baltimore, Maryland; and

§§Vitreoretinal Surgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.

Reprint requests: Lihteh Wu, MD, Instituto de Cirugía Ocular, Apdo 144-1225 Plaza Mayor, San José, Costa Rica (506)2256-2134; e-mail:

Supported by FAPESP (Fundação de Amparo a Pesquisa do Estado de São Paulo) and CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnologico).

Presented in part at the XXX Annual Meeting of the American Society of Retinal Specialists at the Aria Resort, Las Vegas, NV, August 29, 2012.

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

The Pan-American Collaborative Retina Study Group has been listed in Appendix.

© 2013 by Ophthalmic Communications Society, Inc.