Which colour suits the vitreoretinal surgeon?

Vitreoretinal surgery underwent major innovative changes over the past few years in the treatment of traction maculopathies, such as macular puckers and macular holes. The complete removal of epiretinal tissue from the posterior pole is a prerequisite for maximal functional recovery after surgery.1^–4 However, the peeling of an optically semitransparent layer of tissue, which is only a few micrometers thick, such as epiretinal membrane (ERM) and internal limiting membrane (ILM), remains a surgical challenging manoeuvre, even for the more experienced vitreoretinal surgeons. In view of this, the introduction of vital stains allowed precise peroperative identification and delineation of ERM and ILM, enabling surgeons to perform peeling procedures with improved safety and ease. The concept of chromovitrectomy was born and staining tissues during vitreoretinal surgery became a popular procedure.

Since a number of years, three dyes are commonly used in current ophthalmic surgery: indocyanine green (ICG) and infracyanine green, exhibiting an affinity for the acellular ILM;5 and trypan blue, merely staining cellular structures such as epiretinal membranes but also, to a lesser degree, the ILM.6^–8 ICG was the first dye to be …