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OSN Retina 150 Survey
Do concerns of potential cytotoxicity limit your use of trypan blue for visualizing internal limiting and epiretinal membranes for removal?
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Perspective
Judy E. Kim
Because trypan blue has a better safety profile than indocyanine green (ICG), I have used trypan blue in the past but was not too impressed with its staining. It stains mature epiretinal membrane (ERM) well but does not stain internal limiting membrane (ILM) well. Also, having to use it under air for best staining was a deterrent. I would love to use brilliant blue, but it is not FDA approved and our hospital does not allow its use when obtained through a compounding pharmacy. I wish some company would facilitate its usage in the U.S., as our European colleagues are able to use it. As a result, I am using diluted ICG as my staining agent. It stains ILM well for macular hole cases and gives a negative staining for ERM cases, allowing visualization of the edge of the ERM/ILM junction and more complete removal of ERM. It is important to know that ICG has a very narrow window of safe concentration while being able to stain adequately. While it may not matter as much with ERM cases, the surgeon needs to be careful with ICG concentration, amount injected, exposure time and light pipe proximity in cases of macular hole surgery, if ICG is used.
Judy E. Kim, MD
Disclosure: Kim has no relevant financial disclosures.
Perspective
Steve Charles
ICG is the most commonly used stain, and numerous in vitro and clinical studies have shown it to be toxic. Surgeons who use ICG and claim that their “special method” does not cause toxicity have little or no evidence to support this claim. Numerous in vivo and clinical studies have shown brilliant blue green to be safe; unfortunately it must be prepared by a compounding pharmacy in the U.S.
Steve Charles, MD, FACS, FICS
Disclosure: Charles is a consultant for Alcon (Alcon does not have a staining agent).
Results from Survey
Do concerns of potential cytotoxicity limit your use of trypan blue for visualizing internal limiting and epiretinal membranes for removal?
What is your ‘go to’ dye for visualizing posterior segment structures?
