title: The staining pattern of brilliant blue G during macular hole surgery: a clinicopathologic study.
abstract: OBJECTIVE
  To describe the intraoperative staining pattern of the internal limiting membrane (ILM)-specific dye Brilliant Blue G (BBG) in a cohort of patients with idiopathic macular holes; to analyze the associations of the staining pattern with pre- and postoperative variables and to correlate the staining pattern with transmission electron microscopy (TEM) of the excised ILM.
  
  
  METHODS
  Fifty-five consecutive patients were studied. The staining pattern was divided into three subtypes based on the intraoperative appearance. The presence of a narrow rim of nonstaining around the macular hole (MH) edge was noted and measured. In the final 21 patients, the excised ILM was examined with TEM.
  
  
  RESULTS
  The pattern of staining observed was categorized as uniform in 33 patients (60%), patchy nonstaining in 17 (31%), and no visible staining in 5 (9%). The staining pattern correlated with the MH stage. In the patients with uniform or patchy staining, a nonstaining rim was observed in 26 (52%) of the 50. The presence of a rim was associated with a greater hole diameter and lower postoperative visual acuity. The stain pattern correlated significantly with the amount of cellular tissue on the vitreous side of the ILM on TEM, with a greater proportion of multicellular layer membranes and new collagen in the incomplete staining groups.
  
  
  CONCLUSIONS
  A variety of nonstaining patterns around macular holes can be observed using BBG, and these patterns correlate to the amount of cellular tissue on the vitreous side of the ILM seen histologically. These patterns could be used to guide the ILM peeling requirement or extent in future studies.
authors.affiliation: Sunderland Eye Infirmary, Sunderland, United Kingdom Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom.
authors.forename: David H W
authors.initials: DH
authors.lastname: Steel
authors.affiliation: Sunderland Eye Infirmary, Sunderland, United Kingdom.
authors.forename: Christiana
authors.initials: C
authors.lastname: Dinah
authors.forename: Haifa A
authors.initials: HA
authors.lastname: Madi
authors.affiliation: Sunderland Eye Infirmary, Sunderland, United Kingdom.
authors.forename: Haifa
authors.initials: H
authors.lastname: Magdi
authors.affiliation: EM Research Services, Newcastle University, Newcastle Upon Tyne, United Kingdom.
authors.forename: Kathryn
authors.initials: K
authors.lastname: White
authors.affiliation: Faculty of Applied Sciences, University of Sunderland, Sunderland, United Kingdom.
authors.forename: Jon
authors.initials: J
authors.lastname: Rees
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001485:Basement Membrane / Q000473:pathology / Q000601:surgery; D015331:Cohort Studies; D004396:Coloring Agents; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D012394:Rosaniline Dyes; D014821:Vitrectomy / Q000379:methods
chemical_list: D004396:Coloring Agents; D012394:Rosaniline Dyes; C004692:coomassie Brilliant Blue
keywords: Brilliant Blue G; electron microscopy; internal limiting membrane; macular hole; staining; vitrectomy