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Subretinal migration of trypan blue during macular hole and epiretinal membrane peel: an observational case series.
S Ghosh1, S Issa, I El Ghrably
1Department of Ophthamology, Royal Victoria Infirmary, Newcastle, UK.
Purpose:
To report the inadvertent subretinal migration and effect of trypan blue (TB) during staining of the epiretinal membrane (ERM) for macular pucker, and internal limiting membrane during macular hole (MH) surgery, and to suggest alternative safe methods of injecting TB.
Methods:
Three cases in which TB migrated to the subretinal space were followed up on day 1, day 7, day 21, and at 3 months following the initial operation. Two of the cases were operated for MH and one patient had ERM peel. Colour fundus and optical coherence tomography (OCT) were performed on day 1 and on each subsequent visit.
Results:
In both cases of MH the hole was closed postoperatively. The patient with ERM had the membrane peeled successfully as documented by OCT. Clinically, all patients demonstrated chorioretinal atrophy in the area of TB migration. There was thinning of the retina as noted by OCT.
Conclusion:
It is difficult to prove whether the chorioretinal atrophy was caused by the subretinal TB or by the accidental forceful dye injection, but subretinal TB and contact of TB with the retinal pigment epithelium should be avoided, and precautions should be taken during intravitreal injection. We suggest a more controlled method of dye injection in such cases using the flute needle rather than the syringe technique that is conventionally used.
Insights
Subretinal migration of trypan blue (TB) during eye surgery can cause retinal damage. Surgeons should use safer injection methods to avoid this complication and protect vision.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Surgical Complications
Background:
- Macular hole (MH) and epiretinal membrane (ERM) surgeries often involve staining with trypan blue (TB).
- Accidental subretinal migration of TB is a potential complication during these procedures.
Observation:
- This study reports on three cases of inadvertent subretinal TB migration during MH and ERM surgery.
- Patients were monitored postoperatively using fundus photography and optical coherence tomography (OCT).
Findings:
- Successful surgical outcomes for MH closure and ERM peeling were achieved in all cases.
- Clinical examination and OCT revealed chorioretinal atrophy and retinal thinning in areas of TB migration.
- The exact cause of atrophy (TB vs. injection force) remains uncertain.
Implications:
- Subretinal TB migration and contact with the retinal pigment epithelium should be strictly avoided.
- Precautions during intravitreal injection are crucial to prevent retinal damage.
- Utilizing a flute needle for TB injection may offer a safer alternative to traditional syringe techniques.
