title: Subretinal migration of trypan blue during macular hole and epiretinal membrane peel: an observational case series. Is there a safer method?
abstract: OBJECTIVE
  To report the inadvertent subretinal migration and effect of trypan blue (TB) during staining of the epiretinal membrane (ERM) for macular pucker, and internal limiting membrane during macular hole (MH) surgery, and to suggest alternative safe methods of injecting TB.
  
  
  METHODS
  Three cases in which TB migrated to the subretinal space were followed up on day 1, day 7, day 21, and at 3 months following the initial operation. Two of the cases were operated for MH and one patient had ERM peel. Colour fundus and optical coherence tomography (OCT) were performed on day 1 and on each subsequent visit.
  
  
  RESULTS
  In both cases of MH the hole was closed postoperatively. The patient with ERM had the membrane peeled successfully as documented by OCT. Clinically, all patients demonstrated chorioretinal atrophy in the area of TB migration. There was thinning of the retina as noted by OCT.
  
  
  CONCLUSIONS
  It is difficult to prove whether the chorioretinal atrophy was caused by the subretinal TB or by the accidental forceful dye injection, but subretinal TB and contact of TB with the retinal pigment epithelium should be avoided, and precautions should be taken during intravitreal injection. We suggest a more controlled method of dye injection in such cases using the flute needle rather than the syringe technique that is conventionally used.
authors: Department of Ophthamology, Royal Victoria Infirmary, Newcastle, UK.
authors: S
authors: S
authors: Ghosh
authors: S
authors: S
authors: Issa
authors: I
authors: I
authors: El Ghrably
authors: K
authors: K
authors: Stannard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents / Q000009:adverse effects* / Q000493:pharmacokinetics; D019773:Epiretinal Membrane / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012167:Retinal Perforations / Q000601:surgery*; D014343:Trypan Blue / Q000009:adverse effects* / Q000493:pharmacokinetics; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D014343:Trypan Blue