title: Progressive atrophy of retinal pigment epithelium after trypan-blue-assisted ILM peeling for macular hole surgery.
abstract: We report a case of progressive atrophy of the retinal pigment epithelium (RPE) after trypan-blue-assisted peeling of internal limiting membrane (ILM) for macular hole surgery. A 68-year-old Caucasian female underwent a 20-g pars plana vitrectomy for a chronic stage-3 macular hole. The ILM was stained with 0.06% trypan blue (VisionBlue™, DORC Netherlands) for 2 min after fluid air exchange. Dye was reapplied for another 2 min due to poor staining. The ILM was completely removed around the macular hole with forceps. RPE atrophy was noticed at the edge of the hole 1 month after surgery. It progressively increased in intensity and enlarged over 2 years. Her final visual acuity was counting fingers, significantly worse compared to her presenting visual acuity of 20/200. Progressive atrophy of RPE in our patient was most likely due to the toxicity of trypan blue. Reapplication of the dye may increase the likelihood of toxicity.
authors.affiliation: Illinois Retina Institute; Department of Surgery, University of Illinois College of Medicine-Peoria Campus, Peoria, IL, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Jain
authors.forename: Kamal
authors.initials: K
authors.lastname: Kishore
authors.forename: Yog Raj
authors.initials: YR
authors.lastname: Sharma
mesh_terms: D000368:Aged; D001284:Atrophy; D004396:Coloring Agents; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011183:Postoperative Complications; D012162:Retinal Degeneration / Q000209:etiology / Q000473:pathology*; D012167:Retinal Perforations / Q000601:surgery*; D055213:Retinal Pigment Epithelium / Q000473:pathology*; D014343:Trypan Blue; D014792:Visual Acuity; D014821:Vitrectomy / Q000009:adverse effects* / Q000379:methods
chemical_list: D004396:Coloring Agents; D014343:Trypan Blue