Posterior Hyaloid Detachment Research Articles

Feasibility of Direct Vitrectomy-Sparing Subretinal Injection for Gene Delivery in Large Animals

Purpose To assess the safety and feasibility of direct vitrectomy-sparing subretinal injection for gene delivery in a large animal model. Methods The experimental Liběchov minipigs were used for subretinal delivery of a plasmid DNA vector (pS/MAR-CMV-copGFP) with cytomegalovirus (CMV) promoter, green fluorescent protein (GFP) reporter (copGFP) and a scaffold/matrix attachment region (S/MAR) sequence. The eyes were randomized to subretinal injection of the vector following pars plana vitrectomy (control group) or a direct injection without prior vitrectomy surgery (experimental group). Intra- and post-operative observations up to 30 days after surgery were compared. Results Six eyes of three mini-pigs underwent surgery for delivery into the subretinal space. Two eyes in the control group were operated with a classical approach (lens-sparing vitrectomy and posterior hyaloid detachment). The other four eyes in the experimental group were injected directly with a subretinal cannula without vitrectomy surgery. No adverse events, such as endophthalmitis, retinal detachment and intraocular pressure elevation were observed post-operatively. The eyes in the experimental group had both shorter surgical time and recovery while achieving the same surgical goal. Conclusions This pilot study demonstrates that successful subretinal delivery of gene therapy vectors is achievable using a direct injection without prior vitrectomy surgery.

Autologous internal limiting membrane transplantation achieves anatomic closure and functional improvement in the treatment of large, persistent macular holes

PurposeTo evaluate the clinical outcome of subretinal autologous internal limiting membrane (ILM) transplantation during pars-plana vitrectomy for persistent full-thickness macular hole (FTMH) repair.MethodsRetrospective, consecutive case series of 13 eyes (13 patients) undergoing small-incision vitrectomy with ILM transplantation and air tamponade for large persistent FTMH after prior unsuccessful vitrectomy with posterior hyaloid detachment and ILM peeling.Main outcome measurementsFor all eyes, high-definition spectral domain optical coherence tomography scans (SD-OCT Spectralis, Heidelberg Engineering GmbH, Germany) of the macula were routinely performed before surgery, 1 and 4 weeks after surgery, and at the final follow-up visit. Additionally, age, gender, axial length, macular hole diameter, biomicroscopic fundus evaluation and best‐corrected visual acuity (BCVA) at baseline, 1 and 4 weeks after surgery, and at the final follow-up visit were analyzed.ResultsAnatomic closure was achieved in all 13 cases (100% success rate). Closure pattern was classified in accordance with to Rossi et al. (Graefe’s Arch Clin Exp Ophthalmol 258(12):2629–2638, 2020). Mean baseline BCVA logMAR was 0.93, mean postoperative BCVA logMAR was 0.66 with a mean postoperative follow-up period of 11.4 months. No re-opening occurred during the observation period.ConclusionsPlacing an autologous ILM-transplant in the subretinal space beneath the margin of the FTMH can support anatomic restauration and functional improvement in large, persistent FTMHs.

Kaminari Kagura: the “lightning bolt shape” technique for posterior vitreous detachment induction

PurposeTo describe and evaluate the effectiveness of the Kaminari Kagura technique as a posterior hyaloid detachment treatment.Study designThis was a prospective, consecutive, randomized interventional study.MethodsThis study examined 30 eyes from 30 patients divided into two groups: (1) a Kaminari Kagura group (15 eyes) and (2) a control group (15 eyes) scheduled for vitrectomy with an optical coherence tomography (OCT)-based diagnosis of adherent posterior hyaloid.ResultsThe mean time for posterior vitreous detachment (PVD) induction in the Kaminari Kagura group was 58 ± 6.6 s, and that in the control group was 69 ± 9 s (p < 0.005). No intra- or post-operative complications were reported.ConclusionsThe Kaminari Kagura technique results in effective posterior hyaloid detachment in less time than that required for posterior vitreous cortex engagement.

Vitrectomy versus Vitrectomy with Scleral Buckling in the Treatment of Giant Retinal Tear Related Retinal Detachments: An International Multicenter Study

To determine the practice pattern for treating giant retinal tear (GRT) related detachments, and their anatomic and visual outcomes with pars plana vitrectomy (PPV) with or without scleral buckling (SB). Retrospective cohort study. Eyes with GRT detachments repaired from 2008 to 2020 with at least 6 months of follow-up from 7 institutions in North and South America, Europe, and Asia. Eyes repaired using PPV versus PPV/SB were compared. Anatomic and functional outcomes. A comparable number of eyes underwent PPV (n= 101) and PPV/SB (n= 99). Except for history of developmental abnormalities, prior intraocular surgery, and lens status, no differences in baseline demographics, ocular characteristics, or intraoperative surgical adjuncts were observed. The overall single surgery anatomic success (SSAS) at 6 months and 1 year were similar between the groups (82.2% and 77.2% of PPV, and 87.9% and 85.7% of PPV/SB). When stratified by age, the 1-year SSAS rate was higher for PPV/SB (88.5%) than PPV (56.3%) (P= 0.03) for children <18 years. For both children and adults, the mean best-corrected visual acuity (BCVA) at baseline did not differ between the PPV and PPV/SB groups. However, for children, mean BCVA at 1 year was better in the PPV/SB than PPV groups (P= 0.001) while for adults, no difference was found between the 2 groups. The mean time to the first redetachment was 7.9 months in the PPV group and 5.5 months in the PPV/SB group (P= 0.8). Proliferative vitreoretinopathy was the most common cause for redetachment (70.4% of PPV and 93.8% of PPV/SB in redetached eyes; P= 0.1). Postoperative complications were also similar between the 2 groups, including ocular hypertension, epiretinal membrane, and cataract formation. PPV and PPV/SB are equally popular among surgeons globally for managing GRT detachments and have comparable anatomic and visual outcomes in adults. In children, PPV/SB is superior to PPV for anatomic and functional success at 1 year. In adults, the relief of traction by the GRT may reduce peripheral traction and obviate the need for an SB. However, in children, a supplemental SB can be beneficial as complete vitreous shaving and posterior hyaloid detachment, and postoperative positioning, are difficult in this group.

AN ASSOCIATION BETWEEN STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS, PERIPHERAL RETINOSCHISIS, AND POSTERIOR HYALOID ATTACHMENT.

Stellate nonhereditary idiopathic foveomacular retinoschisis is a disorder characterized by splitting of the retina at the macula, without a known underlying mechanical or inherited cause. This study investigates demographic, anatomical, and functional characteristics of subjects with stellate nonhereditary idiopathic foveomacular retinoschisis, to explore potential underlying mechanisms. In this single-site, retrospective, and cross-sectional, observational study, data were collected from 28 eyes from 24 subjects with stellate nonhereditary idiopathic foveomacular retinoschisis. Descriptive statistics were reported, based on the observed anatomico-functional features. The visual acuity remained stable (median 20/20) in all subjects over a median follow-up of 17 months. All cases demonstrated foveomacular retinoschisis within Henle's fiber layer, at the junction of the outer plexiform and outer nuclear layers. This schisis cavity extended beyond the limits of the macular OCT temporally in all eyes. In most affected eyes, there were documented features of peripheral retinoschisis and broad attachment of the posterior hyaloid at the macula. Functional testing in a cross-sectional subset demonstrated normal retinal sensitivity centrally but an absolute scotoma peripherally. Stellate nonhereditary idiopathic foveomacular retinoschisis seems to be associated with peripheral retinoschisis and anomalous or incomplete posterior hyaloid detachment. Despite chronic manifestation, this does not significantly affect central visual function but can manifest with profound loss of peripheral visual function.

Retinal racemose hemangioma and macroaneurysm with multilayered hemorrhage

A 42-year-old female presented with sudden diminution of vision in the right eye (RE) for 1 day. The vision was counting fingers with Relative afferent pupillary defect (RAPD) (RE) and 20/20 (LE). Fundus revealed dilated tortuous arteries and veins in all quadrants with premacular and submacular hemorrhage. Fundus fluorescein angiography (FFA) showed nonleaking vascular loops with hypofluorescence at the macula. Optical coherence tomography (OCT) revealed localized posterior hyaloid detachment with hemorrhage. We report this unilateral case of retinal racemose hemangioma with multilayered hemorrhage managed with pneumatic displacement and revealed retinal artery macroaneurysm in the background. On follow-up there was development of localized vitreomacular traction. It was treated with Yttrium Aluminium Garnet (YAG) hyaloidotomy, which improved vision to 20/80.

Vitrectomy Due to Vitreous Hemorrhage and Tractional Retinal Detachment Secondary to Eales' Disease

Objectives:To investigate visual and anatomical outcomes of vitreoretinal surgeries in patients with Eales’ disease.Materials and Methods:In this retrospective study, 22 eyes of 21 patients with vitreous hemorrhage (VH) or tractional retinal detachment (TRD) secondary to Eales’ disease who underwent vitreoretinal surgery between January 1997 and December 2015 and had at least 1 year of follow-up were included.Results:The mean best corrected visual acuity (BCVA) was significantly higher at final visit (0.6±0.9 logMAR) than the preoperative values (1.8±1.1 logMAR) (p<0.001). After surgery, BCVA was stable in 4 eyes (18.2%), increased in 16 eyes (72.7%), and decreased in 2 eyes (9.1%). Although the mean BCVA was better in the VH group (0.3±0.34 logMAR) than the TRD group (0.9±1.1 logMAR), the difference was not statistically significant (p=0.1). Multivariable linear regression analyses revealed that final BCVA was negatively associated with preoperative or postoperative proliferative vitreoretinopathy grade C (PVR-C), preoperative retinal detachment involving the macula, postoperative neovascular glaucoma, and long preoperative duration of disease, and positively associated with preoperative BCVA. Final BCVA was not associated with preoperative retinal and disc neovascularization, rubeosis iridis, total posterior hyaloid detachment, preoperative retinal laser photocoagulation, indication of surgery, diameter of sclerotomy (20 or 23 gauge), preoperative lens status, preoperative or postoperative epimacular membrane, peroperative iatrogenic retinal breaks, postoperative hypotony, cystoid macular edema, and new or recurrent retinal detachment. The primary anatomic success rate was 81.8% and the final anatomic success rate was 90.9%.Conclusion:In Eales’ disease, good visual results can be obtained with vitreoretinal surgery if the detachment area does not involve the macula and PVR-C does not develop pre- or postoperatively.

Posterior Subhyaloid Precipitates: ‘KPs’ of the Posterior Segment

ABSTRACT Purpose: To describe the course of posterior subhyaloid precipitates (PSPs) accompanying active retinitis. Methods: Retrospective study of three retinitis cases associated with PSPs and literature review. Results: Cases 1 and 2 were Toxoplasma retinochoroiditis. Case 3 had bilateral retinitis post-febrile illness. PSPs were yellowish-white spherical lesions seen in the presence of partial posterior hyaloid detachment (PVD) in the retro-hyaloid space lining the inferior PVD margin. In all 3 cases, PSPs resolved during treatment for primary disease. Resolution of PSPs preceded resolution of retinitis. Literature review revealed similar lesions in CMV retinitis and syphilis in addition to Toxoplasma retinochoroiditis. Conclusion: PSPs were seen in the presence of active retinitis and partial PVD when inflammatory aggregates gravitate inferiorly in the subhyaloid space. They were observed during active retinitis and their resolution preceded the resolution of retinitis, thus providing a potential marker for disease resolution.

Optical coherence tomography findings in toxoplasma retinochoroiditis.

Purpose:This study aimed to evaluate the optic coherence tomography (OCT) findings in patients with toxoplasmic retinochoroiditis (TRC).Methods:A total of 12 eyes of 12 patients with active TRC were included in the study. At baseline, at the first-month follow-up, at the sixth-month follow-up and at the 1-year follow-up, the TRC lesion OCT and macula OCT were evaluated.Results:Hyperreflectivity of the inner retinal layers and an increase in retinal thickness were observed on the OCT examinations of all the patients with an active TRC lesion. The retinal thickness decreased and the reflectivity of retinal layers was disorganized in the OCT images obtained in the follow-up period. Partial posterior hyaloid detachment (PHD) and no PHD were detected in 11 cases and 1 case, respectively. Epiretinal membrane (ERM) had developed in the adjacent region of the scar in 7 patients. With the regression of the lesion, the disruption of the ellipsoid zone (EZ), retinal pigment epithelium (RPE) and external limiting membrane (ELM) improved in the adjacent areas. In all the eyes, ERM and the PHD configuration did progress during the follow-up period. Vitreoschisis was found in 4 of the 11 patients with partial PHD. It was observed that ERM developed in all the patients with vitreoschisis.Conclusion:ERM and partial PHD were common in the TRC patients, and there was no progression during the follow-up period. Regeneration of the EZ, RPE and ELM was observed in the follow-up period.

Comparison of postoperative anterior segment changes associated with pars plana vitrectomy with and without vitreous base shaving.

To compare changes in anterior segment topography and axial length (AL) evaluated with Pentacam and IOL Master after pars plana vitrectomy (PPV) performed with and without vitreous base shaving. This prospective study included patients who underwent PPV or phacoemulsification+PPV (Phaco+PPV) for various indications. Patients who underwent total posterior hyaloid detachment and excessive vitreous base shaving with scleral indentation were referred to as complete PPV (c-PPV). The patients whom posterior hyaloid was separated as far as the posterior arcades and vitreous base shaving with scleral depression was not performed were classified as the partial PPV (p-PPV) group. All patients underwent detailed ophthalmologic examinations preoperatively and 1wk, 1, and 3mo postoperatively. Changes in the anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), central corneal thickness (CCT), and keratometric measurements (K1 and K2) were evaluated with Pentacam HR. Changes in the AL measurements were analyzed with IOL Master. A significant increase in ACD was observed in c-PPV cases (P=0.02), but this increase was not significant in the p-PPV group (P=0.053). In contrast, ICA increased significantly in the c-PPV group (P=0.02) but decreased in the p-PPV group (P=0.09). BCVA was significantly improved in the c-PPV group from week 1 (P<0.001) while the increase in the p-PPV group reached significance at 3mo (P=0.035). CCT increased in the first week and later returned to baseline in both groups. No significant differences in the other parameters were observed between the groups, and there were no significant changes in intraocular pressure, ACV, AL, K1 or K2 values (P>0.05 for all). Incomplete posterior hyaloid excision and not removing the vitreous base in PPV surgeries may create a more stable anterior chamber, thus preventing the downward movement of the lens-iris diaphragm, and may cause ciliary body retraction, thereby reducing ICA. Awareness of these effects can provide some amount of guidance to physicians in selecting the appropriate PPV procedure and preempting surgical complications.

PREOPERATIVE ANATOMICAL FEATURES ASSOCIATED WITH IMPROVED SURGICAL OUTCOMES FOR STAGE 5 RETINOPATHY OF PREMATURITY.

To describe preoperative anatomical features of Stage 5 retinopathy of prematurity with results of surgery and patient-related and surgery-related factors affecting postoperative success. Forty eyes of 33 infants who underwent vitrectomy with lensectomy or lens-sparing vitrectomy for Stage 5 retinopathy of prematurity were enrolled. Stage 5 cases were divided into different groups according to their preoperative anatomical features as follows: A: for eyes with ophthalmoscopically observable total retinal detachment; B: for eyes with total leucocoria associated with funnel retinal detachment; and C: for eyes with very shallow anterior chamber and corneal opacity. Only A and B eyes underwent surgery. The effect of the presence of vascular dilation and tortuosity, preoperative treatment status, surgically induced posterior hyaloid detachment, and sparing the lens on anatomical and functional results was evaluated. Thirty-five percentage of the eyes were in Group A and 65% were in Group B. The mean follow-up was 30.6 months (12-68). Anatomical success was 55.5% for Group A and 15.4% for Group B (P: 0.047), and functional success was 33.3% for Group A and 7.7% for Group B at the third year (P: 0.125). The presence of vascular dilation and tortuosity and postoperative vitreous hemorrhage were found to have negative effects; preoperative treatment and surgical induction of posterior hyaloid detachment were found to have positive effects on anatomical and functional results. Surgery for ophthalmoscopically observable retinopathy of prematurity-associated retinal detachment resulted in better anatomical and functional outcomes, and the results are even better in eyes with preoperative treatment, lens-sparing vitrectomy, and surgically induced posterior hyaloid detachment.

Von Hippel–Lindau disease with concomitant Hodgkin’s disease and congenital hypertrophy of the retinal pigment epithelium

The article presents a rare case of combination of von HippelLindau disease and Hodgkins disease. The disease began with neurological symptoms with gradual progression over the next 3 years. The diagnosis of von HippelLindau disease was made after MRI of brain and spinal cord, abdominal MICTs, and detection of brain stem and spinal cord tumors, multiple pancreatic cysts. We performed resection trepanation of the posterior cranial fossa and microsurgical total removal of hemangioblastoma of the medulla oblongata. After 1.5 years the patient is diagnosed with Hodgkins disease and several courses of chemotherapy are carried out, reaching full remission, confirmed by PET with CT. 14 months later, the patient consulted an ophthalmologist due to visual impairment and floating opacities in her left eye. The ophthalmologic examination for the first time revealed multiple bilateral retinal hemangiomas and vitreal hemorrhages from tractional retinal tears caused by posterior hyaloid detachment and unrelated to hemangiomas in the left eye. The barrier laser coagulation of the left eye retinal tears was performed, and the observation tactics was adopted.

Parameters affecting postoperative success of surgery for stage 4A/4B ROP

PurposeTo describe the long-term anatomical and functional results of surgery for retinal detachment (RD) associated with stage 4 retinopathy of prematurity (ROP) and patient and surgery-related factors affecting postoperative success.DesignRetrospective...

Inverted internal limiting membrane flap technique for very large macular hole.

To assess the anatomical and visual outcome of idiopathic macular holes greater than 1000 µm using the inverted internal limiting membrane flap technique. This retrospective case series included 5 eyes of 5 patients with idiopathic macular hole with base diameter greater than 1000 µm who underwent inverted internal limiting membrane flap technique along with standard 23G pars plans vitrectomy with posterior hyaloid detachment and fluid gas exchange with 12%-14% perfluoropropane (C3F8). Preoperative and postoperative visual acuity and spectral domain optical coherence tomography images were evaluated. The main outcome measures were visual outcome and macular hole closure. Mean age was 63.2±8.4y with all 5 subjects being females. Mean duration of symptoms was 11±14mo with a mean postoperative follow up of 13.2±13mo. The mean base diameter of the macular holes was 1420±84.8 µm (1280-1480 µm). Type 1 closure was achieved in four out of five patients, while one patient had type 2 closure using the inverted internal limiting membrane (ILM) flap technique. Median baseline BCVA was 0.79 logMAR (Snellen's equivalent 20/120) and median final BCVA 0.6 logMAR (Snellen's equivalent 20/80) with mean visual improvement of approximately three lines improvement. No complications related to surgical procedure were noted. The inverted internal limiting membrane flap technique may be promising for very large macular holes with high rate of macular closure and good visual outcome.

Ultrasound findings in ocular trauma

ObjectiveTo evaluate the frequencies of various eye and/or orbital disorders by ultrasound examination in patients with ocular trauma. Materials and methodsThis prospective and descriptive study was conducted on 100 patients with ocular trauma treated in the Conde de Valenciana Institute from March to November 2014. Ultrasound examination was performed primarily using ultrasound B mode, with standardized A mode only used as correlation method. Age, gender, type of trauma, and various ultrasound findings were recorded. ResultsOcular trauma was more frequent in men (83%) compared to women (17%). The left eye was affected in 55%, and right eye in 45%, with 55% being open traumas and 45% blunt traumas. Most cases were young patients with a mean age of 33.7 years, with the group between 41 and 50 years being the most affected. Among the most frequent injuries found was the vitreous hemorrhage (45%) and posterior hyaloid detachment (38%), followed by retinal detachment (32%), and choroidal detachment (18%). ConclusionUltrasound remains as the investigation method of choice in patients with ocular trauma, since it is a simple, cheap and non-invasive study, and can be very useful in providing diagnostic and prognostic information. This study demonstrated that trauma is more common in young men, with vitreous hemorrhage as the most common finding.

Hallazgos ecográficos en trauma ocular

ObjectiveTo evaluate the frequencies of various eye and/or orbital disorders by ultrasound examination in patients with ocular trauma. Materials and methodsThis prospective and descriptive study was conducted on 100 patients with ocular trauma treated in the Conde de Valenciana Institute from March to November 2014. Ultrasound examination was performed primarily using ultrasound B mode, with standardised A mode only used as correlation method. Age, gender, type of trauma, and various ultrasound findings were recorded. ResultsOcular trauma was more frequent in men (83%) compared to women (17%). The left eye was affected in 55%, and right eye in 45%, with 55% being open traumas and 45% blunt traumas. Most cases were young patients with a mean age of 33.7 years, with the group between 41 to 50 years being the most affected. Among the most frequent injuries found was the vitreous haemorrhage (45%) and posterior hyaloid detachment (38%), followed by retinal detachment (32%), and choroidal detachment (18%). ConclusionUltrasound remains as the investigation method of choice in patients with ocular trauma, since it is a simple, cheap and non-invasive study, and can be very useful in providing diagnostic and prognostic information. This study demonstrated that trauma is more common in young men, with vitreous haemorrhage as the most common finding.

Complicação periférica de cirurgia macular em paciente fácico: o que fazer e qual tamponante usar?

We present a case of a 28-year-old male patient undergoing macular surgery for epiretinal membrane (ERM). The surgery was performed using Zeiss non-contact system with good peripheral and macular viewing (two-lens system). During posterior hyaloid detachment, an iatrogenic operculated tear was detected in the nasal quadrant of the retina. Macular surgery was successfully performed; however, we was left SF6 as a tamponade to block the fotcoaguladed operculated hole.. The patient progressed well, with best corrected visual acuity (BCVA) improving from 20/100 to 20/20. After 2 years, the patient complained of blurred vision (the formation of a slight posterior subcapsular cataract) that caused significant discomfort (BCVA worsened to 20/25). Therefore, a multifocal toric intraocular lens IOL (+2.50 add) was implanted in the victrectomized eye and refractive correction in fellow eye (PRK for −2.50 sph.). The patient was satisfied with the postoperative results.

The enzymatic vitreolysis — a new trend in the treatment of retinal vein occlusions

Vitreoretinal relationships exert a significant influence on the course of retinal vein occlusions (RVO) and post-thrombotic retinopathy. A single intravitreal injection of Actilyse 50 mkg in the period from 1 till 21 days from the disease onset stimulates a posterior vitreous detachment in 30.4% patients with non-ischemic and 24.8% patients with the type of ischemic RVO. The process of transition from the partial posterior hyaloid detachment to the complete one, and complete posterior hyaloid detachment in patients who did not have it from the beginning, was accompanied by a visual acuity increase by a factor of 1.5. The use of enzymatic vitreolysis in patients with RVO increases the probability of reduced macular edema in the early disease period, to increases visual acuity, and decreases the risk of neovascularization development in the posterior eyeball segment.

A FORCE-SENSING MICROSURGICAL INSTRUMENT THAT DETECTS FORCES BELOW HUMAN TACTILE SENSATION

To test the sensitivity and reproducibility of a 25-gauge force-sensing micropick during microsurgical maneuvers that are below tactile sensation. Forces were measured during membrane peeling in a "raw egg" and the chick chorioallantoic membrane models (N = 12) of epiretinal membranes. Forces were also measured during posterior hyaloid detachment and creation of retinal tears during vitrectomy in live rabbits (n = 6). With the raw egg model, 0.5 ± 0.4 mN of force was detected during membrane peeling. In the chorioallantoic membrane model, delaminating the upper membrane produced 2.8 ± 0.2 mN of force. While intentionally rupturing the lower membrane to simulate a retinal tear, 7.3 ± 0.5 mN (range, 5.1-9.2 mN; P < 0.001) of force was generated while peeling the upper membrane. During vitrectomy, the minimum force that detached the posterior hyaloid was 6.7 ± 1.1 mN, which was similar to the force of 6.4 ± 1.4 mN that caused a retinal tear. The rate of force generation, as indicated by the first derivative of force generation, was 3.4 ± 1.2 mN/second during posterior hyaloid detachment, compared with 7.7 ± 2.4 mN/second during the creation of a retinal tear (P = 0.04). Force-sensing microsurgical instruments can detect forces below tactile sensation, and importantly, they can distinguish the forces generated during normal maneuvers from those that cause a surgical complication.

POSTERIOR HYALOID DETACHMENT AND INTERNAL LIMITING MEMBRANE PEELING ASSISTED BY ANTHOCYANINS FROM ACAI FRUIT (EUTERPE OLERACEA) AND 10 OTHER NATURAL VITAL DYES

The purpose of this study was to determine whether natural dyes facilitate posterior hyaloid detachment (posterior vitreous detachment [PVD]) and retinal internal limiting membrane (ILM) peeling in human eyes. Open-sky vitrectomy with posterior hyaloid and ILM removal was performed in 86 human cadaveric eyes. After core vitrectomy, 11 different dyes were injected into the vitreous cavity to aid hyaloid detachment and ILM removal. The dyes were allowed to settle on the macula for 5 minutes after PVD and were removed by mechanical aspiration. Intraocular forceps were used for ILM peeling, which was confirmed by light microscopy of the peeled tissue. Acai fruit (Euterpe oleracea) extract and 10 additional dyes from plants or animal sources were tested: pomegranate (Punica granatum), logwood (Haematoxylum campechianum), chlorophyll extract from alfalfa (Medicago sativa), cochineal (Dactylopius coccus), hibiscus (Hibiscus rosa-sinensis), indigo (Indigofera tinctoria), paprika (Capiscum annuum), turmeric (Curcuma longa), old fustic (Maclura tinctoria), and grape (Vitis vinifera). The dyes facilitated PVD and ILM peeling. Acai fruit (E. oleracea) extract, logwood (H. campechianum), cochineal (D. coccus), and old fustic (M. tinctoria) facilitated PVD in all cases; dye-assisted PVD was compared with triamcinolone-assisted PVD performed previously in a comparative model. Acai fruit (E. oleracea) extract, cochineal (D. coccus), and chlorophyll extract from alfalfa (M. sativa) showed the best capability for ILM staining; dye-assisted ILM removal was compared with the ILM peeling guided by indocyanine green staining performed previously in a comparative model. Light microscopy confirmed the ILM removal in all cases. Anthocyanin dye of the acai fruit (E. oleracea) and the dyes from cochineal (D. coccus) and chlorophyll extract from alfalfa (M. sativa) resulted in the best capability for posterior hyaloid and ILM staining in human cadaveric eyes and may be a useful tool for vitreoretinal surgery.