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Double staining with brilliant blue G and double peeling for epiretinal membranes
Hiroyuki Shimada1, Hiroyuki Nakashizuka, Takayuki Hattori
1Department of Ophthalmology, School of Medicine, Nihon University, Surugadai, Kanda, Chiyodaku, Tokyo, Japan. sshimada@olive.ocn.ne.jp
Purpose:
To compare methods of removing epiretinal membranes (ERM) and evaluate the usefulness of the double brilliant blue G (BBG) staining and double-peeling method.
Design:
Prospective, interventional case series.
Participants:
We followed 246 consecutive patients who underwent pars plana vitrectomy to remove ERM and for > or =12 months.
Methods:
Of the 246 eyes, 104 underwent single ERM peeling using indocyanine green staining, and 142 underwent ERM peeling by 1 of the 3 following methods: without staining in 46 eyes, triamcinolone acetonide staining in 42, and BBG staining in 54. Peeling of residual internal limiting membrane (ILM) was then conducted using BBG. In the latter group, the ILM that remained after the initial peeling procedure was evaluated macroscopically with BBG staining and also histopathologically. In 6 eyes requiring reoperation owing to ERM recurrence, the peeled ERM was examined histopathologically.
Main Outcome Measures:
Postoperative visual acuity and recurrence of ERM.
Results:
The ERM recurrence rate was 16.3% (17 eyes) and the reoperation rate was 5.8% (6 eyes) among the 104 eyes that underwent single ERM peeling, compared with 0% in 142 eyes with double ERM and ILM peeling. Although the ERM recurrence rate was significantly lower with double peeling, postoperative visual acuity did not differ between the 2 methods. The 3 ERM peeling methods differed in the rate and extent of residual ILM, and the lowest rate (21/54 eyes; 39%) was achieved with BBG staining (P<0.0001). Histopathologic examination of the ILM remaining after ERM peeling detected remnant ERM cells on the ILM. Histopathologic examination of the peeled ERM in 6 eyes with ERM recurrence showed residual ILM to serve as a scaffold for cell proliferation.
Conclusions:
This study verified that ERM recurrence arises from remnant ERM components on the ILM, which proliferate using the ILM as a scaffold, and that complete ILM removal seems to reduce the risk of recurrence. Brilliant blue G with good affinity for the ILM facilitates simultaneous ERM and ILM peeling in many cases, and BBG contact with the retina in the second staining has no apparent effect on visual acuity. Double BBG staining and double peeling is useful for ERM treatment.
Insights
The double brilliant blue G (BBG) staining and double-peeling method significantly reduces epiretinal membrane (ERM) recurrence after surgery. Complete internal limiting membrane (ILM) removal, facilitated by BBG, is key to preventing ERM regrowth.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Surgical Techniques
Background:
- Epiretinal membranes (ERMs) can cause visual impairment.
- Recurrence of ERMs after surgical removal is a clinical challenge.
- The role of internal limiting membrane (ILM) in ERM recurrence is under investigation.
Purpose of the Study:
- To compare different methods for removing ERMs.
- To evaluate the efficacy of the double brilliant blue G (BBG) staining and double-peeling technique.
- To assess the impact of complete ILM removal on ERM recurrence.
Main Methods:
- Prospective interventional case series of 246 patients undergoing pars plana vitrectomy for ERM.
- Comparison of single ERM peeling (n=104) with double ERM and ILM peeling (n=142).
- Utilized indocyanine green, triamcinolone acetonide, and BBG staining for ERM removal; BBG used for residual ILM peeling.
Main Results:
- Double ERM and ILM peeling resulted in a 0% recurrence rate, compared to 16.3% with single ERM peeling.
- Postoperative visual acuity did not significantly differ between the methods.
- BBG staining demonstrated the lowest rate of residual ILM (39%), confirmed by histopathology showing remnant ERM cells on ILM.
Conclusions:
- ERM recurrence is linked to remnant ERM components on the ILM, which proliferate using the ILM as a scaffold.
- Complete ILM removal appears to significantly reduce the risk of ERM recurrence.
- The double BBG staining and double-peeling method is effective for ERM treatment with no adverse effect on visual acuity.
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