RETINAL PIGMENT EPITHELIAL IRREGULARITY AND ATROPHY AFTER INTERNAL MEMBRANE PEELING: A REPORT OF TWO CASES. Issue Volume 16:Issues 3(2022) (22nd January 2020)

• Record Type: Journal Article
• Authors: Shroff, Daraius; Agarwal, Aniruddha; Saha, Indranil; Aggarwal, Kanika; Grover, Suman; Gupta, Vishali; Shroff, Cyrus; Querques, Giuseppe
• Is Part Of: Retinal cases & brief reports. Volume 16:Issues 3(2022)
• Page Start: 275
• Page End: 279
• Publication Date: 2020-01-22
• Subjects: phototoxic maculopathy -- phototoxicity -- brilliant blue-green -- dye -- endoilluminator -- pars plana vitrectomy; Retina -- Diseases -- Periodicals; Retina -- Periodicals; Retinal Diseases -- Periodicals; Retina -- Case Reports; Retinal Diseases -- Case Reports; 617.7
• DOI: 10.1097/ICB.0000000000000972
• Languages: English
• ISSNs: 1935-1089

Abstract

Abstract : Two patients underwent 25-gauge pars plana vitrectomy with internal limiting membrane peeling using brilliant blue-green dye. After an uncomplicated surgery, both the patients developed retinal pigment epithelial clumping and atrophy involving the macula and peripapillary nasal retina. Possible mechanisms for this include retinal phototoxicity, dye toxicity, or a combination of both. Abstract : Purpose: To report two cases of widespread retinal pigment epithelial clumping, irregularity, and atrophy after uncomplicated 25-gauge pars plana vitrectomy with brilliant blue-green–assisted internal limiting membrane peeling. Methods: Retrospective analysis of 2 eyes of 2 patients who underwent 25-gauge pars plana vitrectomy for macular diseases (macular hole with retinal detachment and vitreomacular traction) was performed. Surgical notes and video recordings were reviewed to determine the surgical procedures performed and the duration of the surgery. Multimodal imaging analysis, including fundus photography, fundus autofluorescence imaging, and optical coherence tomography were performed to determine the pathological changes in the postoperative period. Results: The mean age of the patients (all females) was 78 years. In all the patients, brilliant blue-green–assisted internal limiting membrane peeling was performed without any intraoperative complications. Four weeks after an uncomplicated surgery, the patients complained of progressive central visual disturbance and metamorphopsia. Retinal imaging demonstrated retinal pigment epithelial clumps and irregularity, which appeared as hyperautofluorescent on fundus autofluorescence, and widespread retinal pigment epithelial atrophy (hypoautofluorescent on fundus autofluorescence) in the posterior pole and peripapillary region, along with retinal and choroidal thinning. Conclusion: In uncomplicated vitrectomy consisting of brilliant blue-green–assisted internal limiting membrane peeling, a remote risk of widespread retinal pigment epithelial damage exists even with the use of modern endoilluminators and relatively short surgical duration. Retinal phototoxicity seems to be the primary cause; however, dye-related cytotoxicity or a combination of both cannot be ruled out.