Second generation vital stains in retinal surgery
- UCSF Department of Ophthalmology 10 Kirkham Street, K301 San Francisco, CA 94143, USA; bhisit@itsa.ucsf.edu
Further innovations may enable novel surgical strategies
In an article in this issue of the BJO by Stalmans and colleagues (p 713) and another recently by Li and colleagues,1 the novel vital stains trypan blue (TB) and infracyanine green are investigated clinically. These vital stains are promising in vitreoretinal surgery as alternatives to the by now familiar agent indocyanine green (ICG). Firstly, a brief history of membrane staining. ICG, a fluorescent dye used in choroidal angiography, was recognised for its potential in the operating room by cataract surgeons, who first used it to stain the anterior capsule to facilitate capsulorrhexis in difficult cases. Vitreoretinal surgeons, taking notice of their anterior segment colleagues’ success, soon found that ICG similarly stained the internal limiting membrane (ILM) of the retina. This was important because peeling of the nearly invisible ILM from the retinal surface had recently been advocated in macular hole surgery2,3; this was easier said than done, however, until the arrival of ICG made ILM peeling easier, faster, and less traumatic. Thus, a trend in posterior segment surgery was born, and ICG soon enjoyed widespread attention. A flurry of articles appeared, with several early clinical series reporting impressive success rates in macular hole surgery with ICG assisted ILM peeling.4,5 ICG staining has by now entered the mainstream of retinal surgery as a useful tool in macular hole repair and epiretinal membrane removal.
But, more recently, some doubts have arisen around ICG, as a critical reassessment has followed the initial enthusiasm. As discussed by …
