Ultrastructure and retinal imaging of internal limiting membrane: a clinicopathologic correlation of trypan blue stain in macular hole surgery.
OBJECTIVE
The purpose of this study was to correlate the ultrastructural morphology of epiretinal and retinal tissue with optical coherence tomography assessment and to investigate the effects of trypan blue staining on internal limiting membrane (ILM) tissue.


METHODS
This was a prospective case-comparative study. Consecutive patients were recruited and underwent ILM peel with 0.5 mL of 0.15% trypan blue, and these were compared with a nonrandomized control group (unstained ILM). Patients underwent optical coherence tomography scanning preoperatively and postoperatively at 1.5 and 3 months. Data were collected prospectively to include Snellen visual acuity, macular hole, and operative characteristics. Internal limiting membrane was examined by transmission electron microscopy.


RESULTS
Sixty-four patients underwent macular hole surgery, and complete data were available on 49 patients (17 control subjects and 32 patients who had peeling of stained ILM). Trypan blue staining significantly improved ease and completeness of ILM removal. There was no significant difference in vision, optical coherence tomography characteristics, or macular hole closure rate at 3 months between stained and unstained groups. There was no ultrastructural evidence of alteration of the plane of ILM separation in cases in which trypan blue was used.


CONCLUSIONS
Trypan blue stain from these data seems to improve the ease and completeness of the ILM peeling (assessed clinically) and does not show any signs of toxicity.
Mackenzie
Sarah E
SE
Moorfields Eye Hospital, London, UK. blobby1029@hotmail.com
Gandorfer
Arnd
A
Rohleder
Matthias
M
Schumann
Ricarda
R
Schlottmann
Patricio G
PG
Bunce
Catey
C
Xing
Wen
W
Gregor
Zdenek
Z
Charteris
David G
DG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D046529:Microscopy, Electron, Transmission / Q000379:methods; D008875:Middle Aged; D011446:Prospective Studies; D012160:Retina / Q000473:pathology* / Q000648:ultrastructure*; D012167:Retinal Perforations / Q000175:diagnosis* / Q000601:surgery*; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014343:Trypan Blue
D004396:Coloring Agents; D014343:Trypan Blue