Staining of the internal limiting membrane with intravitreal triamcinolone acetonide

To evaluate the use of triamcinolone acetonide to stain the internal limiting membrane (ILM) during vitreoretinal surgery.

A prospective clinical interventional case series study was performed, including 16 patients who underwent pars plana vitrectomy. Seven patients had proliferative diabetic retinopathy with macular edema. Seven patients had epiretinal membranes. One patient had a retinal detachment with a cystoid macular edema and proliferative vitreoretinopathy. One patient had a pseudophakic cystoid macular edema. After vitrectomy, 2 mL triamcinolone acetonide suspension was injected into the vitreous cavity. The ILM was peeled, as it was evidenced by the particles of triamcinolone that adhered to its surface. The ultrastructure of tissue harvested during surgery was analyzed using transmission electron microscopy in selected cases to confirm the presence or absence of ILM.

After the injection of triamcinolone, the visualization of the vitreous base and hyaloid was excellent in all patients. The particles of triamcinolone deposited on the retinal surface enabled the ILM to be stained. Once removed, the ILM was clearly distinguishable, floating in the vitreous cavity with particles of triamcinolone adhering to its surface. Ultrastructural analysis of tissue collected during vitrectomy confirmed that the removed tissue represented ILM.

We observed that triamcinolone acetonide can be useful in staining the internal limiting membrane, thus greatly facilitating the retinal ILM peeling. The absence of particles of triamcinolone on the underlying retina enables the area where the ILM has already been removed to be identified.