A 2021 systematic review and network meta-analysis (NMA) of 17 studies, including five randomized controlled trials and twelve retrospective trials, evaluated the efficacy of various dyes for assisting internal limiting membrane (ILM) peeling in patients with idiopathic macular hole (IMH). The analysis examined 1,492 participants undergoing ILM peeling assisted with chromovitrectomy dyes such as indocyanine green (ICG), trypan blue (TB), brilliant blue G (BBG), and triamcinolone acetonide (TA), comparing different concentrations of these dyes in terms of IMH closure rates and postoperative visual acuity (VA). The trials utilized a frequentist framework to calculate the mean difference and odds ratio for different dye concentrations, including 0.05% BBG, 0.15% TB, 0.5% ICG, 0.25% ICG, and 40 mg/ml TA, among others. The NMA aimed to establish the optimum dye concentration for improving anatomical outcomes such as IMH closure and functional recovery like VA. The analysis showed that the ILM peeling procedure assisted by 0.15% TB and 0.05% BBG demonstrated a significantly higher IMH closure rate compared to other concentrations, with SUCRA values indicating that these dyes ranked first and second in terms of efficacy. In contrast, 0.25% ICG showed inferior outcomes, ranking last in IMH closure probability. For postoperative visual acuity, peeling performed without any dye ranked as the most effective, suggesting better visual recovery without dye-related toxicity. Peeling with 0.5% ICG, while demonstrating modest anatomical success, resulted in poorer visual outcomes than TB, BBG, or no dye at all. The analysis acknowledges the potential retinal toxicity associated with chromovitrectomy dyes, and supports the use of lower-concentration dyes like 0.05% ICG or other alternatives like TB and BBG for safer outcomes. [1]
A 2020 systematic review and NMA (N= 27 studies incorporating 1,849 eyes) aimed to compare the outcomes of four adjuvant dyes— ICG, BBG, TA, and TB —used for ILM peeling in macular hole surgery. This analysis evaluated postoperative best-corrected visual acuity (BCVA) improvement and primary macular hole (MH) closure rates and used random-effects Bayesian models to allow for indirect comparisons across the four adjuvants. The results demonstrated that BBG and TA outperformed ICG, with BBG showing significantly greater BCVA improvement compared to ICG (weighted mean difference [WMD] 0.08; 95% credible interval [CrI] 0.01 to 0.16). TA was ranked highest in BCVA improvement, although this was not statistically significant when compared to ICG (WMD 0.09; 95%CrI -0.00 to 0.19). Regarding primary macular hole closure rates, BBG was found to be the most likely adjuvant to achieve favorable outcomes, with a higher probability of success than the other dyes. However, no significant differences were observed between any two groups in primary closure rates. These findings suggest that BBG and TA may provide superior visual outcomes, with BBG being particularly effective in promoting anatomical closure during ILM peeling for macular hole surgery. [2]
A 2014 poster abstract presented at the Association for Research in Vision and Ophthalmology (ARVO) annual conference compared the use of BBG and TB when performing lens capsule staining for cataract surgery. This pilot study randomized patients aged 40-80 years diagnosed with cataracts to undergo either TB 0.1%-assisted capsulorhexis or BBG 0.025%-assisted capsulorhexis. Results found BBG as effective as TB for staining the lens capsule and visualization during surgery. No significant differences were observed in VA, intraocular pressure, corneal edema, or inflammation of the anterior chamber. [3]
A 2011 experimental study evaluated the capsule-staining properties and biocompatibility of the triarylmethane dyes methyl blue and aniline blue compared to the established dyes patent blue and TB, utilizing cultured human corneal endothelial cells. Corneal endothelial cell cultures were derived from human donor cells and exposed to varying concentrations of the four dyes (0.025 to 5.0 mg/mL). Cytotoxicity was assessed using an MTT assay after 24 hours of incubation, with calcein live cell staining conducted concurrently. Additionally, lens capsule staining was performed in vitro using pig lenses soaked in varying concentrations of the dyes (0.5, 1.5, and 2.5 mg/mL), and staining properties were evaluated using a semiquantitative scoring system. The results revealed that methyl blue and patent blue showed no significant cytotoxicity at any tested concentration, whereas aniline blue exerted significant cytotoxic effects at concentrations of 1.5 mg/mL or higher and trypan blue at concentrations of 2.5 mg/mL or higher. In terms of capsule-staining properties, the triarylmethane dyes yielded sufficient staining intensity for capsulorhexis creation, although at higher concentrations compared to TB. Notably, TB provided superior staining intensity at lower concentrations, while methyl blue demonstrated quicker fading after washing than other dyes. These findings suggest that methyl blue and patent blue offer a more favorable safety profile regarding corneal endothelial cell viability, positioning them as viable alternatives for cataract surgery. [4]