Dyes in Ocular Surgery: Principles for Use in Chromovitrectomy

PURPOSE: To present the current state-of,the-art in. formation regarding the properties, indications, surgical techniques, and toxic effects of current and past applications of vital dyes in chromovitrectomy. DESIGN: Critical analysis and surgical perspective of the literature and recent studies. METHODS: Review, interpretation, and commentary regarding the most relevant experimental as well as clinical studies including the authors' clinical and laboratory research. RESULTS: There is a consensus that the application of vital dyes facilitates the delicate removal of intraocular membranes during vitreoretinal surgery. Controversy still remains around various issues, mainly potential toxicity and safety. There is room for further investigation of novel and specific vital dyes. Dyes such as Evans blue and light green may stain the internal limiting membrane very well, whereas fast green and indigo carmine may be very safe to the retina. However, comparing the staining and toxicity data has revealed that Bromophenol blue and Brilliant blue may be even better novel agents. The dyes currently used for different steps in chromovitrectomy are: triamcinolone acetonide for vitreous identification; indocyanine green, infracyanine green, and Brilliant blue for internal limiting membrane identification; and Trypan blue for epiretinal membrane identification. CONCLUSIONS: Clear-cut safety profiles for the different dyes in chromovitrectomy have not yet been established, and current state-of-the-art staining-assisted procedures should be performed using concentrations and volumes as low as possible. (Am J Ophthalmol 2009;148:332-340. (C) 2009 by Elsevier Inc. All rights reserved.)