title: Double visualization using triamcinolone acetonide and trypan blue during stage 3 macular hole surgery.
abstract: OBJECTIVE
  To study the usefulness of intravitreal injection of triamcinolone acetonide and trypan blue for facilitating visualization and dissection of the posterior vitreous cortex and internal limiting membrane (ILM) during vitrectomy in idiopathic stage 3 macular holes.
  
  
  METHODS
  Pars plana vitrectomy was performed in 10 eyes of 10 patients with idiopathic stage 3 macular holes. After core vitrectomy had been performed, triamcinolone acetonide was injected over the posterior pole. After separation of the visualized posterior vitreous cortex, trypan blue was injected over the macular area. Excised specimens were examined by electron microscopy.
  
  
  RESULTS
  Upon injection of triamcinolone acetonide, the posterior vitreous cortex and residual vitreous cortex could be visualized in all patients. The posterior vitreous cortex and residual vitreous cortex were completely removed. The ILM of the retina was stained faint blue and was successfully removed in all patients. Electron microscopy revealed that the triamcinolone-acetonide-visualized layer and the trypan-blue-stained layer had different histological features. No complications related to the use of triamcinolone acetonide and trypan blue were encountered.
  
  
  CONCLUSIONS
  Double visualization of the posterior vitreous cortex and ILM using triamcinolone acetonide and trypan blue during vitrectomy may facilitate separation of the posterior vitreous cortex from the retina and removal of the ILM around the macular hole in patients with idiopathic stage 3 macular holes.
authors.affiliation: Department of Ophthalmology, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. naruy@cick.jp
authors.forename: Narumichi
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Noriko
authors.initials: N
authors.lastname: Ozaki
authors.forename: Kimio
authors.initials: K
authors.lastname: Murakami
mesh_terms: D000368:Aged; D001485:Basement Membrane / Q000648:ultrastructure; D004396:Coloring Agents; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D013194:Staining and Labeling / Q000379:methods; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide; D014343:Trypan Blue; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods
chemical_list: D004396:Coloring Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D014343:Trypan Blue