6.
Sandwich Colouring of the Vitreoretinal Interface
Jörg C. Schmidt (Marburg)
Background: Initial historic considerations to perform a pars plana vitrectomy were made for
opaque vitreous cortex due to dense asteroid hyalosis or vitreous hemorrhages. However
current indications for a vitreo-retinal surgery include mainly vitrectomies in eyes with a clear
vitreous e. g. retinal detachment, epiretinal membranes or macular holes, thus a proper visualization
of the transparent vitreous gel during surgery is helpful.
Material and methods: The transparent structure of the vitreous cortex as well as thin epiretinal
membrane may become visible during surgery by mild vitreal hemorrhages or intravitreal
application of 0.05 ml crystalline triamcinolone acetonide. The inner limiting membrane (ILM)
can be stained by indocyanine green (ICG) in the fluid filled eye.
Results: Mild accidental intraoperative bleedings or intended injection of 0.05 mg autologous
blood may help to stain transparent vitreous structures and visualize remaining vitreous. Intravitreal triamcinolone crystals
attach to the surface of vitreous cortex, bursa premacularis or retina itself allowing better visualization of a controlled vitreous
removal. Whereas the vitreous gel can be visualized by triamcinolone, ICG is necessary to selectively stain the ILM.
Discussion: A safe and complete removal of clear vitreous or transparent membranes may be achieved by the intraoperative
application of autologous blood or triamcinolone. The application of different dyes is helpful to colour different structures
of the vitreoretinal interface.