The purpose of this work is to report the injection of subretinal trypan blue to identify occult retinal breaks during vitrectomy for rhegmatogenous retinal detachment (RRD) repair.


Case report of a patient with RRD in whom the causative retinal break could not be found during surgery, even after scleral indentation. Trypan blue 0.15% was injected into the peripheral subretinal space using a 39 g cannula after injection of perfluorocarbon liquid (PFCL) in the vitreous cavity for macular protection. The vitreous cavity was further filled with PFCL such that the trypan blue was vented out from the subretinal space through the occult retinal break. The trypan blue escaped from the subretinal space forming a smokestack-like column, allowing the occult break to be identified. After identifying the retina break, subretinal fluid was drained and surgery was completed using endolaser and gas tamponade. This technique allowed the successful completion of a RRD surgery in which retinal defects could not be identified pre and intraoperatively. One single retinal break was successfully found using this procedure and treated with endolaser photocoagulation, as well as the retinal puncture site where the trypan blue was primarily injected. After reabsortion of the gas tamponade, the retina remained attached and the patient achieved 20/50 after 3 months follow-up.

Effectiveness / Safety:

In patients where causative retinal breaks cannot be found, potentially compromising the outcome of the retinal detachment surgery, this technique can be a safe and effective alternative approach to identify those defects.

Contact Details:

Email: filipe.henriques.oftalmologia@gmail.com
Cell Phone: +351918362497

Filipe Henriques