Brilliant Blue G toxicity in macular hole surgeries: A report on combined phototoxicity and dye-induced macular damage

ABSTRACT

Purpose

Vitrectomy with brilliant blue G (BBG) assisted internal limiting membrane (ILM) peeling is the standard operational technique in macular hole surgeries. However, BBG dye, though considered safe and nontoxic, can also occasionally lead to macular toxicity. This study aims to describe the clinical features and characteristics of four eyes who developed macular toxicity after following surgery for macular hole repair.

Methods

Retrospective review of four consecutive cases of macular toxicity after conventional BBG assisted ILM peeling. All the cases reviewed, their operative surgical notes were retrieved and analyzed. The ILM was stained twice during surgery with prolonged intraoperative surgical time.

Results

All four cases had a prolonged surgical time and the ILM was stained twice during surgery in all cases. The area of macular toxicity was corresponding to the area of ILM peeling which had been exposed to repeated staining by BBG dye. By the end of one month, all four cases had foveal thinning along with choriocapillary atrophy. The mean BCVA was 20/80 before surgery and the final mean visual acuity was <20/800.

Conclusion

This report highlights the occurrence of macular and choriocapillary atrophy due to prolonged focal endoillumination and the increased risk of toxicity with repeated dye staining.

KEYWORDS:

• Macular hole
• Internal limiting membrane peeling
• Endoillumination
• Brilliant blue G
• Macular toxicity and atrophy

AUTHOR’S NOTE

The contents of this article have not been presented at any national or international meeting.

Written informed consent was obtained from the patient before the submission of this article.

DISCLOSURE STATEMENT

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

AUTHOR CONTRIBUTIONS

MT, JC, AS were involved in data evaluation, interpretation, and drafting of the manuscript. AS, DCP, NKS, RRP were involved in the clinical care and management of the cases. AD, DCP were involved in literature search, evaluation and interpretation along with critical revision of the manuscript for intellectual content. All authors critically reviewed and approved the final manuscript. All authors met the ICMJE criteria, and all those who fulfilled those criteria are listed as authors. All authors had access to the study data and made the final decision about where to publish these data and approved submission to this journal.

CONSENT TO PARTICIPATE

A written informed consent was taken from the patients for inclusion and for publication in this case series

CONSENT FOR PUBLICATION

The authors affirm that human research participants provided informed consent for publication of the images in Figure(s) 1, 2, 3 and 4.

Additional information

Funding

Support provided by Hyderabad Eye Research Foundation, Hyderabad, India. The funders had no role in the preparation, review or approval of the manuscript.