Advantages:

To review current visualization aids for VR surgery with respect to their specific features and clinical applications. Furthermore, to correlate the various staining patterns with the underlying pathology.

Methods:

ICG, trypan blue, brilliant blue and the combination trypan blue/brilliant blue as well as triamcinolone serve for visualization of the vitreous, proliferative vascular and non-vascular epiretinale membranes and the ILM. Intraoperative findings and corresponding OCT- and FAG-pictures are demonstrated.

Effectiveness / Safety (Results):

Preoperative OCT can assist in interpreting subtle findings, in particular vitreoretinal interface changes. Intraoperatively, visibility of the transparent tissue components can be improved using supravital dyes and triamcinolone crystals. The dyes mentioned above show different staining patterns dependent on the type of tissue bound to. This allows a kind of in vivo diagnosis of the tissue operated on (membranous vitreous cortex remnants, epiretinal gliosis, ILM). Triamcinolone mainly adheres to vitreous fibres and serves for subtle cortex remnants visualization.

Take home message:

Both, OCT findings and dye- or triamcinolone-assisted vitreoretinal surgery have significant diagnostic and surgical impacts. A significant number of eyes show complex vitreomacular changes, such as multilayered membranes in which vitreous, newly formed epiretinal tissue and an altered ILM are involved. In addition, posterior vitreoschisis complicating the VR pathology (diabetic and highly myopic eyes) can be specifically addressed.

Thus, the use of visualization aids during vitreous surgery does not only allow easier and more complete peeling maneuvers, but also enables us to distinguish between different tissue components.