American Journal of Ophthalmology AJO 02 333 R 2 Page 1
Trypan blue-assisted peeling of the internal limiting membrane during
macular hole surgery
Manuel Perrier M.D., Mikaël Sébag M.D., FRCP(C)
Ophthalmology department, Centre Hospitalier Université de Montréal Pavillon Notre-
Dame, Montréal, Québec, Canada
Objective Evaluate the outcome of surgeries for macular holes using trypan blue to
facilitate delamination of the internal limiting membrane(ILM).
Methods A retrospective series of 18 patients. All patients underwent a three-port pars
plana vitrectomy with ILM delamination using trypan blue 0,06% to assist visualisation.
The main outcome measures were postoperative visual acuity and clinically evident
retinal pigment epithelial changes.
Results The median preoperative visual acuity was 20/200 and the median postoperative
visual acuity was 20/70. All but one macular hole were closed after surgery (94%). At
the last recorded follow-up, 10 patients (56%) had improved their visual acuity of at least
2 chart lines. No adverse reaction related to trypan blue was observed up to 1 year after
Conclusion Trypan blue staining of ILM may accomplish more complete dissections of
the ILM and better surgical and visual outcomes.
We believe that trypan blue (TB) staining facilitates visualisation and delineation of the
internal limiting membrane (ILM). The purpose of this study is to evaluate the visual
outcome of patients who have undergone trypan blue-assisted macular hole surgery.
Our study is a noncomparative retrospective review of a consecutive series of patients
who had undergone macular hole surgery using trypan blue to assist in visualisation of
the ILM. 22 patients charts were reviewed for the study with 4 excluded due to : history
of a rhegmatogenous retinal detachment, incomplete chart information, macular scars or
atrophy previous to the surgical intervention using trypan blue.
The surgical procedure for macular hole repair included a standard three-port pars plana
vitrectomy. A total of 0,5 to 1 ml of trypan blue 0,06% (visionblue, D.O.R.C.
international) was injected under continuous infusion over the posterior pole under direct
visualisation, staining the internal limiting membrane. A 20-gauge bent
microvitreoretinal blade was then used to incise the ILM and intraocular forceps were
used to remove it in a circumferential manner, 360
around the macular hole.