Abstract
Even though it is visual feedback that drives the VR surgeon’s intraoperative decision-making process and thus his every maneuver, the tissues that he needs to deal with are not always readily visible. This explains the birth of this rather new field: using agents to create or enhance contrast so that the safety, precision, and completeness of tissue delineation are increased. Agents can be employed to make the vitreous, newly formed membranes, and the ILM more conspicuous, and the surgeon must know which agent to use, when, and how.
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- 1.
Healthy vitreous, ILM, fine epiretinal membranes.
- 2.
TA does not stain the vitreous (or the ILM; see below); it only marks the tissue.
- 3.
Whether via spontaneous bleeding or surgeon-injected blood.
- 4.
Triesence (Alcon, Fort Worth, TX, USA).
- 5.
MembraneBlue (DORC, Zuidland, The Netherlands), which can also be used subretinally to identify retinal breaks.
- 6.
And other proliferative membranes on the retinal surface (see below, Sect. 34.4).
- 7.
MembraneBlue-Dual (brilliant blue G + trypan blue; DORC, Zuidland, The Netherlands).
- 8.
Brilliant Peel (Geuder GmbH, Heidelberg, Germany), ILM-Blue (DORC, Zuidland, The Netherlands).
- 9.
The use of ICG is described here.
- 10.
For example, the previous surgery was done elsewhere and the ILM peeling was not noted in the discharge summary. This, unfortunately, is not that rare.
- 11.
It is not really an issue in eyes without a macular hole (i.e., no dye access to the subretinal space).
- 12.
Having followed what is outlined here, I have not seen a single case of toxicity in several thousands of eyes with ICG staining.
- 13.
Water.
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© 2016 Springer International Publishing Switzerland
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Kuhn, F. (2016). Chromovitrectomy. In: Vitreoretinal Surgery: Strategies and Tactics. Springer, Cham. https://doi.org/10.1007/978-3-319-19479-0_34
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DOI: https://doi.org/10.1007/978-3-319-19479-0_34
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