A MODIFIED STAINING STRATEGY IN STAIN-ASSISTED VITRECTOMY

The objective of this study is to assess pros and cons of intraoperative Briliant Blue G dye (BBG) injection in the early phase of Pars Plana Vitrectomy. This is a prospective non-consecutive case series study, a modification in timing for dye injection during vitrectomy. A single injection of 0.1 ml of Briliant Blue G (BBG dye) was used in the early phase of pars plana vitrectomy (PPV) promptly after an initial small core vitrectomy, and continued directly in completing vitrectomy; including induction of posterior vitreous detachment and peripheral vitrectomy +/vitreous base shaving. View of the underlying retina is initially obscured immediately after dye injection, however dye density fade gradually with continuation of vitrectomy. Fluid Turbulence caused by vitrectomy and continuous fluid infusion enhance dye dissemination within vitreous cavity and stain transparent tissues and also increase colour contrast between blue hued retina and underlying naturally red coloured choroid. Early staining technique will remove necessity for Air-Fluid Exchange for staining at end of vitrectomy. This study was conducted in the Ophthalmology department at Hamad General Hospital in Doha, Qatar in 2016 and General Port Hospital in Basrah, Iraq in 2017. Patients requiring vitrectomy for various indications were included. Thirty four eyes (34 patients) were involved in this study: 20 men and 14 women, average age 56 was years. Indications for surgery were variable, diabetic vitrectomy (20 cases, 5/16= Macular Epiretinal Membrane), Rhegmatogenous Retinal Detachment (10 cases), Full Thickness Macular hole (2 case), Penetrating Injury with Posterior IOFB (2 cases). Single case required additional re-injection of dye to augment staining. Non-diathermy drainage Retinotomy was done by soft tipped cannula in 5 cases of retinal detachment. No single case has developed a surgically significant discolouration of lens posterior capsule or seepage of dye to the subretinal space. In conclusion, this modified staining technique allows better visualization of the various vitreoretinal tissues during all steps of PPV and improve surgical techniques. Introduction he use of vital dyes in the vitrectomy procedure allows visualisation of the transparent pre-retinal tissues and membranes. Improper visualization of different vitreoretinal tissue layers can lead to incomplete vitreous removal, iatrogenic breaks, long surgical time, and gliosis. Various methods of staining vitreoretinal tissues, particularly the Internal Limiting Membrane (ILM) and Epiretinal Membrane (ERM), have been described to aid visualization of ILM and ERM. Chromovitrectomy is the use of chemicals to stain semi-transparent preretinal structures as an aid in successful vitreoretinal surgery. Several different dyes have been tried including indocyanine green (ICG), trypan blue (TB) and Triamcinolone (TA). Dye administration usually done by 2 techniques at late stage of Pars Plana Vitrectomy (PPV). The “dry” or “airfilled” technique, where only the macular region receives the dye, and mostly no staining of the extra-macular tissue. The “wet” or “fluid-filled” technique results in low intensity staining due to dilution effect. This study aimed to assess intraoperative advantages of modification T A modified staining strategy in stain-assisted vitrectomy Fareed A. W. Al-Laftah