Comparative Evaluation of Brilliant Blue Staining Using Whole Blood Versus Conventional Brilliant Blue Staining in Macula Hole Surgery
Purpose
To evaluate the usefulness of autologous heparinized whole blood (WB) in preventing toxicity of Brilliant Blue (BB) dye and to compare the structural and functional outcome of use of WB with BB versus Conventional BB assisted internal limiting membrane (ILM) peeling in Macula Hole (MH) surgery.
Methods
Full thickness idiopathic and traumatic MH of < 12 months duration were included. Patients with MH size>750µ, significant cataract, atrophic retinal pigment epithelium and associated choroidal rupture were excluded. Sixty eyes of 60 patients were randomly divided equally in two groups. Group A patients underwent MH surgery using autologous heparinized WB followed by BB dye for staining ILM while patients in Group B underwent conventional BB staining. Clinical assessment and spectral domain optical coherence tomography was done at baseline and 3 weeks, 6 weeks, 16 weeks and 6 months postoperatively.
Results
Group A patients had a significantly higher best corrected visual acuity (BCVA) as compared to Group B at all postoperative visits (p<0.001 at 3 and 6 weeks, 0.004 at 16 weeks and 0.04 at 6 months). Eyes in group A had significantly higher outer foveal thickness (OFT) at 3 weeks (p=0.001) and 6 weeks (p<0.001) compared to Group B. Inner segment ellipsoide continuity was noted in greater number of eyes in Group A compared to Group B (p=0.02, 0.002, 0.003 and 0.03 at 3, 6, 16 weeks and 6 months).
Conclusion
Use of WB prior to staining ILM with BB causes earlier and better visual rehabilitation postoperatively which could be attributed to earlier photoreceptor regeneration as evidenced by inner segment ellipsoide continuity and increase in OFT.