Objective:

Epiretinal membranes are sometimes multilayered which needs peeling more than once during vitrectomy. Although some surgeons prefer not to peel ILM in the surgical management of ERMs; ILM peeling is shown to decrease the recurrence of ERMs while not affecting the visual outcome. Different dyes may be used to stain ERM and ILM, although toxicity concerns still exist especially regarding the use of ICG. Also multiple times of injecting the dye after peeling ERM is a potential concern for toxicity of exposed retina with partially peeled ILM.

Purpose:

In this prospective, interventional case series the efficacy and safety of combined peeling of ERM and ILM with the single injection of membrane blue-dual® dye in eyes with idiopathic ERM is evaluated.

Methods:

23-g pars plana vitrectomy (PPV) with ERM and ILM peeling with the use membrane blue-dual® dye is performed. Phacoemulsification with IOL implantation is also added if necessary. Changes in visual acuity, and central macular thickness with complication rates is evaluated. Follow-up with ≥6 months are included.

Results:

15 cases operated between November 2011 – September 2012 are included. 8 eyes had PPV + phako surgery, whereas 7 eyes had PPV. Mean age of 3 pseudophakic and 12 phakic patients was 67.11±5.65. Mean VA increased significantly at 6th month (p<0.05). Mean CMT decreased from 502±35 to 277±43 µ at 6th month (p<0.05). No recurrence of ERM is observed. Cataract progression developed in all 4 phakic eyes, which needed surgery at 10th month postoperative.

Conclusion:

In this study combined peeling of ERM and ILM with the single injection of membrane blue-dual® dye in eyes with idiopathic ERM is found to be effective and safe preventing recurrence of ERMs. The main objective was to decrease mechanical trauma of sequential peeling while avoiding injecting dyes more than once. Membrane blue-dual® consisting trypan blue and brilliant blue is found to be effective to stain both ERM and ILM. Cataract progression precludes increase in VA after PPV in phakic eyes, which necessitates lens surgery in follow-up in this age group.