Use of heavy Trypan blue in macular hole surgery

Intraocular dyes facilitate the identification of the inner limiting membrane (ILM) during surgery. Appropriate dyes should be safe, provide adequate staining, and be easy to use. Heavy Trypan blue eliminates the need for an air-fluid exchange (AFX) and appears to have little retinal toxicity. This study refers to a prospective, consecutive trial with heavy Trypan blue in macular hole surgery.

A consecutive group of 20 patients with full thickness macular holes was recruited in a single institution study. Patients were operated using conventional methods. Heavy Trypan blue was prepared by mixing isovolumetrically glucose 10% with MembraneBlue (DORC, Zuidland, The Netherlands). Patients were assessed for ease of surgery and post-operatively at 3 and 6 months (vision and ocular coherence tomography) for hole closure and vision.

Twenty eyes were included in the study. Reapplication of dye was used in 75% of the cases, leading to improved contrast further facilitating the ILM peel. In no case was an AFX necessary to obtain sufficient staining. Macular hole closure was achieved in 19 of 20 patients with one surgery. No retinal detachment or other complication was observed in the follow-up period.

Heavy Trypan blue can be delivered efficiently to the retinal surface without the need for an AFX. Staining was sufficient to help visualise and peel the ILM. Repeat applications were easily performed. The macular hole closure rate was similar to that of other series with a comparable visual improvement.