Comparison of vitrectomy with brilliant blue G or indocyanine green on retinal microstructure and function of eyes with macular hole

Ophthalmology. 2012 Dec;119(12):2609-15. doi: 10.1016/j.ophtha.2012.06.048. Epub 2012 Aug 24.


Purpose: To evaluate the microstructure of the inner and outer retina and the visual function after macular hole (MH) surgery using brilliant blue G (BBG) or indocyanine green (ICG) to make the internal limiting membrane (ILM) more visible.

Design: Comparative, retrospective, interventional case series.

Participants: Sixty-three eyes of 63 consecutive cases with MH were studied. Thirty-five eyes of 35 cases were treated with BBG between January and August 2011. Twenty-eight eyes of 28 MH cases were treated with ICG from April 2009 through April 2010.

Methods: Vitrectomy was performed with a 23-gauge system and 0.25 mg/ml BBG or with 0.125% ICG.

Main outcome measures: The best-corrected visual acuity (BCVA) and the microperimetry-determined retinal sensitivity were measured at baseline and at 3 and 6 months after surgery. The length of the defect of the photoreceptor inner segment/outer segment (IS/OS) junction and external limiting membrane (ELM), the central foveal thickness (CFT), and the thickness of the ganglion cell complex (GCC) were measured in the spectral-domain optical coherence tomographic images.

Results: The average BCVA was significantly better in the BBG group than in the ICG group at 3 months (P = 0.021) and 6 months (P = 0.045) after surgery. The mean retinal sensitivity in the BBG group was improved significantly in the central 2° at 3 and 6 months (P = 0.001 and P = 0.030, respectively), but was not significantly improved in the adjacent 10°. The length of IS/OS junction defect was significantly shorter in the BBG group at 3 months (P = 0.048), but was not significantly different at 6 months (P = 0.135). The length of ELM defect and the GCC thickness were not significantly different between the 2 groups at 3 and 6 months. The CFT was significantly thinner in the ICG group than in the BBG group at 3 and 6 months (P = 0.013 and P = 0.001, respectively).

Conclusions: The postoperative BCVA and retinal sensitivity in the central 2° were better in eyes after BBG-assisted vitrectomy. The restoration of IS/OS junction was faster in the BBG group, and the CFT was significantly thinner in eyes after ICG. Brilliant blue G may be a better agent than ICG to make the ILM more visible.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Basement Membrane / pathology
  • Coloring Agents*
  • Epiretinal Membrane / physiopathology
  • Epiretinal Membrane / surgery
  • Female
  • Humans
  • Indocyanine Green*
  • Male
  • Microsurgery
  • Middle Aged
  • Retinal Ganglion Cells / pathology
  • Retinal Perforations / physiopathology
  • Retinal Perforations / surgery*
  • Retinal Photoreceptor Cell Inner Segment / pathology
  • Retinal Photoreceptor Cell Outer Segment / pathology
  • Retrospective Studies
  • Rosaniline Dyes*
  • Tomography, Optical Coherence
  • Visual Acuity / physiology*
  • Visual Field Tests
  • Visual Fields / physiology
  • Vitrectomy / methods*


  • Coloring Agents
  • Rosaniline Dyes
  • Indocyanine Green
  • coomassie Brilliant Blue