Before seeing the advantages of the ILM Blue in ERM surgery, compared to the other dyes, we must analyze what we want to dye: ERM is composed on:

  • A plaque of posterior hyaloid which is a collagen 2 structure responsible of reflection and metamorphopsia.
  • The ILM (one micron collagen 4 structure) invaded by glial proliferation (astrocytes and Mueller cell end-feet filled with microfibrils of GFAP).

ILM peeling works because, when we remove the ILM, we also remove the Mueller cell end feet so that we should rather say “Mueller cell feet removal”. So we want to differentiate the posterior hyaloid from the Mueller cell end-feet.

Trypan blue is not a selective dye and therefore does not allow to differentiate the Mueller cell from the hyaloid.

The ILM Blue (blue of coomassie) is specifically linked to arginine, tyrosine, tryptophan, histidine and phenylalanine, proteins of the cellular plasmatic membranes located at the level of the ILM, this is to say the astrocytes and the Mueller cells end feet, exactly what we want to remove; but it does not dye the ILM and the Posterior hyaloid which are collagen 2 and 4 and are proteins of the extracellular matrix.

Many advantages in using ILM Blue:

  • We use a product known to be less toxic than ICG and Trypan Blue.
  • We better understand the pathogeny and the disease.
  • We decrease the number of manipulations (if we want to remove both hyaloid and Mueller cell feet in the same time, we know where to start the peeling).
  • We avoid mistakes, for example in case of spontaneous tearing of the ILM we avoid to touch the fibers layer.

Contact Details:

Email: ddd@club-internet.fr
Cell Phone: +33685555202

Didier Ducournau