Haritoglou Christos, Strauss Rupert, Priglinger Siegfried G, Kreutzer Thomas, Kampik Anselm
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Retina. 2008 Feb;28(2):333-9. doi: 10.1097/IAE.0b013e31814fb0ff.
To describe visualization of the vitreous and the posterior hyaloid membrane using bromophenol blue during vitrectomy for macular hole and retinal detachment.
Six patients with macular holes and four with retinal detachments were included in the study. Before and after surgery, complete clinical examination, including funduscopy and measurements of best-corrected visual acuity and intraocular pressure, was performed. Additional functional tests, such as fluorescein angiography, optical coherence tomography (Stratus OCT; Carl Zeiss Meditec, Jena, Germany, Germany), Goldmann perimetry, and multifocal electroretinography as well as photography of the posterior pole, were performed for macular hole patients. Bromophenol blue was used in concentrations of 0.2%. During macular hole surgery, the dye was injected into the air-filled globe, while during surgery for retinal detachment, the globe was partially filled with perfluorocarbon before dye injection after induction of a posterior vitreous detachment to stain the vitreous peripherally.
Bromophenol blue provided sufficient staining of the attached posterior hyaloid membrane and vitreous remnants in the periphery. This was especially helpful for patients in whom a posterior vitreous detachment could not be induced mechanically by suction using the vitrectomy probe alone, as seen in three of six interventions for a macular hole in this series. In addition, staining of the vitreous or vitreous remnants in the periphery and at the vitreous base was seen in all patients and helped to completely remove the vitreous in a controlled fashion. After macular hole surgery, increase of visual acuity from 20/100 (mean) to 20/40 was seen during follow-up up to 6 months. In one case, the hole persisted and required a second operation. Finally, closure of the hole was achieved in all patients. After retinal detachment surgery, reattachment was achieved in all cases. No dye-related adverse events were seen during follow-up as shown by the functional tests (visual acuity measurement, electroretinography, and perimetry) applied.
Delineation of the vitreous and the posterior hyaloid using bromophenol blue staining greatly facilitates vitreoretinal procedures. Bromophenol blue appeared to be a very helpful and safe tool to visualize the posterior hyaloid membrane in macular hole surgery and assured its complete separation from the retinal surface. The dye also helped to remove vitreous at the vitreous base during retinal detachment surgery. Therefore, bromophenol blue appears as a very good alternative to triamcinolone, which has been used for this purpose, because the dye has no pharmacological properties and no side effects are likely to occur such as cataract formation and increase in intraocular pressure. Further studies including larger numbers of patients are mandatory.
描述在黄斑裂孔和视网膜脱离玻璃体切除术中使用溴酚蓝对玻璃体及后玻璃体膜的可视化情况。
本研究纳入6例黄斑裂孔患者和4例视网膜脱离患者。手术前后均进行了全面的临床检查，包括眼底镜检查、最佳矫正视力和眼压测量。黄斑裂孔患者还进行了额外的功能检查，如荧光素血管造影、光学相干断层扫描（Stratus OCT；德国耶拿卡尔蔡司医疗技术公司）、Goldmann视野检查和多焦视网膜电图以及后极部摄影。使用浓度为0.2%的溴酚蓝。在黄斑裂孔手术中，将染料注入充满空气的眼球内，而在视网膜脱离手术中，在诱导后玻璃体脱离后，在注入染料前先将眼球部分填充全氟碳化合物，以周边染色玻璃体。
溴酚蓝能充分染色附着的后玻璃体膜及周边的玻璃体残余物。这对仅使用玻璃体切除探头抽吸无法机械性诱导后玻璃体脱离的患者尤其有帮助，本系列6例黄斑裂孔手术中有3例出现这种情况。此外，所有患者均可见周边及玻璃体基底部的玻璃体或玻璃体残余物被染色，有助于以可控方式完全清除玻璃体。黄斑裂孔手术后，随访6个月期间，视力从平均20/100提高到20/40。1例患者裂孔持续存在，需要再次手术。最终，所有患者的裂孔均闭合。视网膜脱离手术后，所有病例均实现视网膜复位。应用的功能检查（视力测量、视网膜电图和视野检查）显示，随访期间未观察到与染料相关的不良事件。
使用溴酚蓝染色描绘玻璃体和后玻璃体膜极大地促进了玻璃体视网膜手术。溴酚蓝似乎是黄斑裂孔手术中可视化后玻璃体膜并确保其与视网膜表面完全分离的非常有用且安全的工具。该染料在视网膜脱离手术中也有助于清除玻璃体基底部的玻璃体。因此，溴酚蓝似乎是已用于此目的的曲安奈德的非常好的替代物，因为该染料无药理特性，且不太可能出现如白内障形成和眼压升高等副作用。必须进行包括更多患者的进一步研究。
