title: Accidental subretinal brilliant blue G migration during internal limiting membrane peeling surgery.
abstract: OBJECTIVE
  This case report describes a man who developed retinal changes in his right eye associated with brilliant blue G migration into the subretinal space during 2 years of follow-up.
  
  
  METHODS
  The patient's best-corrected visual acuity in the right eye was 20/70 before surgery, and it improved to 20/25 at 1 year after surgery. Fluorescein angiography showed staining during the late phase in the central macula at all follow-up visits after surgery. Multifocal electroretinography demonstrated normal amplitude and implicit times before surgery but decreased amplitudes and increased implicit times in at least 5 contiguous hexagons after surgery on all 3 examinations performed during the 2-year follow-up period. These functional changes were not topographically correlated with the area of fluorescein staining or with the internal limiting membrane peeled area, but were matched to the area where brilliant blue G accidentally entered the subretinal space. Microperimetry demonstrated reduced retinal threshold sensitivity, particularly in areas with decreased multifocal electroretinography amplitude.
  
  
  CONCLUSIONS
  Despite the visual acuity improvement observed in this case, multifocal electroretinography and microperimetry indicate that subretinal brilliant blue G might cause focal macular damage with a decrease of macular function suggestive of a toxic effect.
authors.affiliation: Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Felipe P P
authors.initials: FP
authors.lastname: Almeida
authors.affiliation: Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Ana Claudia
authors.initials: AC
authors.lastname: De Lucca
authors.affiliation: Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania3Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
authors.forename: Ingrid Ursula
authors.initials: IU
authors.lastname: Scott
authors.affiliation: Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jorge
authors.affiliation: Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil.
authors.forename: Andre
authors.initials: A
authors.lastname: Messias
mesh_terms: D001485:Basement Membrane / Q000473:pathology / Q000601:surgery; D004596:Electroretinography; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000601:surgery*; D005451:Fluorescein Angiography; D006801:Humans; D007202:Indicators and Reagents / Q000009:adverse effects*; D007431:Intraoperative Complications; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000139:chemically induced* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D020419:Photoreceptor Cells, Vertebrate / Q000187:drug effects*; D012394:Rosaniline Dyes / Q000009:adverse effects*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014821:Vitrectomy
chemical_list: D007202:Indicators and Reagents; D012394:Rosaniline Dyes; C004692:coomassie Brilliant Blue