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Sequential epiretinal membrane removal with internal limiting membrane peeling in brilliant blue G-assisted macular surgery
  1. Ricarda G Schumann1,
  2. Arnd Gandorfer1,
  3. Kirsten H Eibl1,
  4. Paul B Henrich2,
  5. Anselm Kampik1,
  6. Christos Haritoglou1
  1. 1Department of Ophthalmology, Vitreoretinal and Pathology Unit, Ludwig-Maximilians-University, Munich, Germany
  2. 2Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
  1. Correspondence to Dr Ricarda G Schumann, Department of Ophthalmology, Vitreoretinal and Pathology Unit, Ludwig-Maximilians-University, Mathildenstr. 8, Munich 80336, Germany; ricarda.schumann{at}


Purpose To assess the selectivity of brilliant blue G (BBG) staining by analysing the morphological components of unstained and stained tissue obtained during epiretinal membrane (ERM) removal with internal limiting membrane (ILM) peeling in BBG-assisted macular surgery.

Methods Twenty-six surgical specimens were removed from 13 eyes with epiretinal gliosis during vitrectomy using BBG for ERM and ILM peeling. We included eyes with idiopathic macular pucker, idiopathic macular hole and vitreomacular traction syndrome. The dye was injected into the fluid-filled globe. Unstained and stained epiretinal tissue was harvested consecutively and placed into separate containers. All specimens were processed for conventional transmission electron microscopy.

Results The first surgical specimen of all eyes showed no intraoperative staining with BBG and corresponded to masses of cells and collagen. The second surgical specimen demonstrated good staining characteristics and corresponded to the ILM in all patients included. In seven eyes, the ILM specimens were seen with minor cell proliferations such as single cells or a monolayer of cells. Myofibroblasts, fibroblasts and astrocytes were present. In five cases, native vitreous collagen fibrils were found at the ILM. In six of the eyes, ILM specimens were blank.

Conclusion Our clinicopathological correlation underlines the selective staining properties of BBG. The residual ILM is selectively stained by BBG even when a small amount of cells and collagen adheres to its vitreal side. To reduce the retinal exposure to the dye, the surgeon might choose to remove the ERM without using the dye, followed by a BBG injection to identify residual ILM.

  • Vitreous
  • retina
  • macula
  • pathology
  • treatment surgery

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  • Presented in part at the Annual Meeting of the Deutsche Ophthalmologische Gesellschaft, Berlin, Germany, September 2009.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the local institutional review board and ethics committee of the Ludwig-Maximilians-University Munich.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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