Indian Journal of Ophthalmology

: 2002  |  Volume : 50  |  Issue : 4  |  Page : 357--358

In reply

L Verma, Moolchand, G Prakash, Hem K Tewari 

Correspondence Address:
L Verma

How to cite this article:
Verma L, Moolchand, Prakash G, Tewari HK. In reply.Indian J Ophthalmol 2002;50:357-358

How to cite this URL:
Verma L, Moolchand, Prakash G, Tewari HK. In reply. Indian J Ophthalmol [serial online] 2002 [cited 2021 Mar 8 ];50:357-358
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Full Text

 Dear Editor,

We appreciate Dr. Verma's comments on our article 'Indocyanine Green Enhanced Maculorhexis in Macular Hole Surgery' (Indian J Ophthalmol 2002;50:123-26). They have used trypan blue, which is a water-soluble acidic vital dye, thus staining dead cells of epiretinal membranes (ERM) better. The internal limiting membrane, a living tisuse, requires a supra-vital stain like Indocyanine green. This dye stains the ILM uniformly deep bottle green. In our personal experience, ILM is stained poorly by 0.06% trypan blue, which is the presently available concentration. Hence ILM peel by trypan blue may not be satisfactory as the poorly stained membrane may not be uniformly visible. Moreover the contrast of the underlying unstained retina is also not as good as that when ICG is used.

Recently a higher concentration of trypan blue (0.2% membrane blue, DORC, the Netherlands) has been proposed for ILM peeling.

We agree with Dr. Verma regarding the cost of ICG dye. But advantages of ICG is the uniform staining of the ILM. This facilitates peeling the ILM as a single sheet and causes less trauma to the underlying retina. Thus the surgical results of ICG assisted ILM peeling is likely to be superior to trypan blue assisted peeling of the ILM, and higher closure rates in macular hole surgery.

We, therefore, would still strongly recommend ICG dye for ILM peel in macular hole surgery and reserve the present 0.0.6% trypan blue for staining and removing epiretinal membranes (ERM) in vitreoretinal surgery and of course for anterior capuslorhexis.