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LETTER TO EDITOR
Year : 2003  |  Volume : 51  |  Issue : 1  |  Page : 106

Trypan blue enhanced vitrectomy in clear gel vitrectomy.



Correspondence Address:
L Verma


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Source of Support: None, Conflict of Interest: None


PMID: 12701876

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How to cite this article:
Verma L, Prakash G, Tewari HK. Trypan blue enhanced vitrectomy in clear gel vitrectomy. Indian J Ophthalmol 2003;51:106

How to cite this URL:
Verma L, Prakash G, Tewari HK. Trypan blue enhanced vitrectomy in clear gel vitrectomy. Indian J Ophthalmol [serial online] 2003 [cited 2020 Apr 5];51:106. Available from: http://www.ijo.in/text.asp?2003/51/1/106/14724

Dear Editor,

Vitreous surgery in cases with penetrating trauma, posterior break retinal detachment, macular hole, or traction retinal detachment require near-total clear gel vitrectomy. Leaving behind too much vitreous can compromise the surgical outcome. This process of cutting the clear gel is often difficult and usually frustrating, especially for beginners. Even modifications, like using gas to induce PVD or using the illuminator probe at an angle to produce the Tyndall effect, do not always work.

We have used intraoperative trypan blue dye [Figure - 1]a to stain this clear vitreous gel in more than 10 cases so far. Intravitreal trypan blue is safe and has been used to stain experimental membranes.[1] Trypan blue stained vitreous [Figure - 1]b is easily visualised against clear infusion fluid. Trypan blue is available in a sterile 1ml ampoule. The contrast of trypan blue against the underlying retina greatly facilitates the identification and cutting of vitreous by demarcating the margins of the vitreous strands [Figure - 1]c. The surgical procedure remains virtually the same. Following core-vitrectomy, the undiluted trypan blue dye is squirted in the vitreous cavity and the ports are closed for 5 minutes with infusion canula turned on (turned off while staining the macular ILM[2]). A striking blue-stained vitreous gel is then visualised.

Trypan blue stained vitreous is easily identifiable and anterior vitrectomy can then be completed with relative ease. In phakic eyes, the posterior capsule (PC) also gets stained with the dye. But this staining gets washed off as quickly as it occurs, because of continuous fluid influx through the infusion canula once the vitrectomy is resumed. Moreover, this PC staining can be utlized to protect the iatrogenic PC injury by performing anterior vitrectomy quickly, as the stained PC is better identified than an unstained one. We believe this technique would facilitate a thorough removal of clear vitreous gel.

 
  References Top

1.
Feron EJ, Veckeneer M, Ginderdeuren RP, Lommel AV, Melles GRJ, Stalmans P. Trypan blue staining of epiretinal membranes in proliferative vitreoretinopathy. Arch Ophthalmol 2002;120:141-44.  Back to cited text no. 1
    
2.
Kumar A, Prakash G, Singh RP. Indocyanine green enhanced maculorhexis in macular hole surgery. Indian J Ophthalmol 2002;50:123-26.  Back to cited text no. 2
    


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