PREVENTING THE DEPOSITION OF TRIAMCINOLONE IN MACULAR HOLE BY USE OF WHOLE BLOOD IN TRIAMCINOLONE-ASSISTED MEMBRANE PEELING

COMPARATIVE EVALUATION OF SEQUENTIAL INTRAOPERATIVE USE OF WHOLE BLOOD FOLLOWED BY BRILLIANT BLUE VERSUS CONVENTIONAL BRILLIANT BLUE STAINING OF INTERNAL LIMITING MEMBRANE IN MACULAR HOLE SURGERY

PURPOSE

To compare the structural and functional outcome of use of autologous heparinized whole blood before staining internal limiting membrane with brilliant blue (BB) versus conventional BB-assisted macular hole surgery.

METHODS

Sixty eyes of 60 patients were randomly divided equally in Group A (BB staining using whole blood) and Group B (conventional BB staining). Clinical assessment and spectral domain optical coherence tomography was done at baseline and 3 weeks, 6 weeks, 16 weeks, and 6 months postoperatively.

RESULTS

Group A eyes had a significantly higher best-corrected visual acuity as compared with Group B postoperatively (P < 0.001, <0.001, 0.004, 0.04 at 3, 6, 16 weeks, and 6 months). Inner segment/outer segment junction continuity was noted in greater number of eyes in Group A compared with Group B (P = 0.02, 0.002, 0.003, and 0.03 at 3, 6, 16 weeks, and 6 months). Eyes in Group A had significantly higher outer foveal thickness at 3 weeks (P = 0.001) and 6 weeks (P < 0.001) compared with Group B.

CONCLUSION

Use of whole blood before staining internal limiting membrane with BB causes earlier and better visual rehabilitation postoperatively, which could be attributed to earlier photoreceptor regeneration as evidenced by inner segment/outer segment junction continuity and increase in outer foveal thickness.

Comparative Evaluation of Retinal Nerve Fiber Layer Thickness After Conventional Brilliant Blue Assisted Internal Limiting Membrane Peeling Versus Brilliant Blue Selective Staining Using Whole Blood in Macular Hole Surgery

BACKGROUND AND OBJECTIVE

To evaluate retinal nerve fiber layer (RNFL) thickness after conventional brilliant blue (BB) assisted macular hole (MH) surgery versus BB selective staining using whole blood (WB) in MH surgery.

PATIENTS AND METHODS

Sixty eyes with stage 4 idiopathic MH with a clear media were randomly divided into two equal groups. Group A eyes underwent sequential intraoperative use of autologous heparinized WB followed by BB dye for staining internal limiting membrane, whereas eyes in group B were subjected to conventional BB staining. Clinical examination and spectral-domain optical coherence tomography was done preoperatively and postoperatively up to 6 months.

RESULTS

Mean global RNFL thickness and mean temporal RNFL thickness decreased in both groups postoperatively, but the reduction in RNFL thickness in group B was greater than group A at all postoperative visits (P < .05).

CONCLUSION

BB toxicity may be responsible for reduction of RNFL thickness and WB appears to protect RNFL against dye toxicity. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:436-442.].

Ophthalmic use of blood-derived products

There is a wide spectrum of blood-derived products that have been used in many different medical and surgical specialties with success. Blood-derived products for clinical use can be extracted from autologous or allogeneic specimens of blood, but recombinant products are also commonly used. A number of blood derivatives have been used for a wide range of ocular conditions, from the ocular surface to the retina. With stringent preparation guidelines, the potential risk of transmission of blood-borne diseases is minimized. We review blood-derived products and how they are improving the management of ocular disease.