Scleral cross-linking using riboflavin and ultraviolet-a radiation for prevention of progressive myopia in a rabbit model.

Our study demonstrates the effect of scleral cross-linking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. Axial length of the eyeball was measured by A-scan ultrasound in 22 New Zealand white rabbits aged 13 days. The right eyes then underwent 360-degree conjunctival peritomy with (experimental group, n = 11) or without (control group, n = 11) scleral cross-linking, followed by tarsorrhaphy. The left eyes served as a control eye. In the experimental group, the right eyeballs were divided into quadrants, and every quadrant had either 2 (n = 8) or 6 (n = 3) scleral irradiation zones, each with an area of 0.2 cm² and radius of 4 mm. Cross-linking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones at 20 s before ultraviolet-A irradiation and every 20 s during the 200-s irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm² (total UVA light dose, 57 J/cm²). Tarsorrhaphies were removed on day 55, followed by repeated axial-length measurement. In the control group, mean axial length in the right eyes increased from 10.50 ± 0.67 mm at baseline to 15.69 ± 0.39 mm 55 days later, for a mean change of 5.19 ± 0.85 mm. In the experimental group, corresponding values were 10.68 ± 0.74 mm and 14.29 ± 0.3 mm, for a mean change of 3.61 ± 0.76 mm. The between-group difference in the change in mean axial length was statistically significant (p < 0.001, Mann-Whitney nonparametric test). The present manuscript demonstrates that scleral cross-linking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

Intravitreal bevacizumab treatment for exudative age-related macular degeneration with good visual acuity.

PURPOSE: To investigate the effect of intravitreal bevacizumab on the visual and anatomic outcome of patients with exudative age-related macular degeneration presenting with good visual acuity (VA). METHODS: A file review was performed for all consecutive patients with newly diagnosed exudative age-related macular degeneration and initial VA of ≥ 20/40 treated in 2005 to 2010 and followed for at least 6 months. Treatment consisted of 3 loading doses of intravitreal bevacizumab every 6 weeks and was repeated when fluid or hemorrhage was present. RESULTS: The cohort included 130 patients (150 eyes). Mean follow-up was 20.2 ± 13.2 months, and mean number of injections was 11.3 ± 6.2. At the last examination, VA was stable or improved in 106 eyes (70.7%); 11 eyes (7.3%) lost ≥ 3 lines. Mean logarithm of the minimum angle of resolution VA measured 0.22 ± 0.1 (0-0.3) at presentation and 0.22 ± 0.2 (0-1.3) at the last visit. Corresponding values for central macular thickness were 267 ± 75 µm (137-562) and 226 ± 75 µm (75-568) (P = 0.14). The most frequent complication (18 eyes, 12%) was corneal epithelial defects. CONCLUSION: Prompt intravitreal bevacizumab treatment for newly diagnosed exudative age-related macular degeneration in patients with good initial best-corrected visual acuity is associated with sustained or improved vision and a good safety profile. Attempts should be made to expedite the access of these patients to treatment, regardless of initial VA.

Intravitreal bevacizumab as an adjunct treatment for neovascular glaucoma.

PURPOSE: To assess the effect of adjunctive intravitreal bevacizumab treatment on neovascular glaucoma (NVG). METHODS: The medical records of all consecutive patients with NVG treated with intravitreal bevacizumab at our center from May 2006 to February 2008 were reviewed. The data collected included background features, findings on full ophthalmologic examination (including visual acuity, gonioscopy, and intraocular pressure), glaucoma medications prescribed, and additional procedures for glaucoma performed before and after bevacizumab injection.The interval between the diagnosis of NVG and intravitreal bevacizumab treatment was calculated. RESULTS: Eighteen patients (6 male, 12 female; mean age 63-/+13.2 years) met the study criteria. Causes of NVG were proliferative diabetic retinopathy (n=14), central retinal vein occlusion (n=2), occlusive vasculitis (n=1), and panuveitis (n=1). The mean duration of followup was 52 (-/+12) weeks. Mean intraocular pressure decreased from 32.3 (-/+4.99) to 18 (-/+6.1) mmHg (p<0.0001) and mean number of glaucoma medications decreased from 3.16 (-/+1.2) to 2.55 (-/+1.46) (p=0.1938). An interval of less than 6 months between the start of bevacizumab treatment and diagnosis was associated with better final visual acuity than delayed treatment (0.82-/+0.4 logMAR vs 1.88-/+1.1 logMAR, p=0.002) and a better regression of iris neovascularization (22% vs 89%; p=0.015). CONCLUSIONS: Intravitreal bevacizumab is beneficial for the treatment of anterior segment neovascularization and NVG when used as an adjunct, making the administration of additional treatment for the underlying cause possible. Bevacizumab should be instituted promptly after diagnosis, before irreversible anatomic and functional damage occurs.

The slower the better: on the instability of gas jets in a model of pneumatic retinopexy.

PURPOSE: To investigate the effect of injection technique parameters on the formation of multiple gas bubbles in a porcine eye model for pneumatic retinopexy. METHODS: Three hundred twenty-four adult porcine eyes were injected with 0.4 mL of C3F8 with variations in the depth of injection, speed of injection, and size of needle bore. The number of gas bubbles in the eye was assessed with indirect ophthalmoscopy. RESULTS: Shallow injections resulted in a higher incidence of a single bubble than did deep injections (P < 0.001; Fisher exact and Wilcoxon rank sum tests). Slow injections were significantly advantageous in producing a single gas bubble during shallow as well as during deep injections (P < 0.001, Fisher exact and Wilcoxon rank sum tests). With a shallow needle insertion, the slow speed of injection produced a single bubble in 75.9% of the eyes, whereas moderately brisk injections resulted in one bubble in 50.9% of the eyes. During deep needle insertion, 44.4% of the eyes had one bubble if the gas was injected slowly and only 11.1% had a single bubble with moderately brisk gas injections. The bore of the needle did not significantly change the number of bubbles during deep or shallow injections. CONCLUSIONS: The factors that were found to be important in reducing the formation of multiple gas bubbles in the eye were shallow depth of injection and slow speed of gas delivery.

Peripheral retinopathy and maculopathy in high-dose tamoxifen therapy.

PURPOSE: To describe the clinical, angiographic, and optical coherence tomography (OCT) features of high-dose tamoxifen retinopathy in three male patients. DESIGN: Observational case series. METHODS: A review of history, clinical examination, and findings on fluorescein angiography (FA) and optical coherence tomography (OCT) was conducted. RESULTS: Three male patients receiving high-dose tamoxifen therapy sought treatment for vision loss and a crystalline maculopathy. Crystalline deposits were noted in the peripheral retina of two patients. All the patients showed macular leakage by FA, but cystoid macular edema (CME) on OCT was detected in two patients. Inner retinal hyperreflective deposits were identified by OCT in all the patients. CONCLUSIONS: High-dose tamoxifen therapy may result in peripheral crystalline retinopathy in addition to perifoveal opacities. Angiographic evidence of macular edema may not unanimously correlate with presence of CME on OCT in these cases.

Surgical and functional results of augmented superior oblique muscle z-tenotomy in patients with superior oblique overaction and Brown's syndrome.

BACKGROUND AND OBJECTIVE: To compare the effectiveness of augmented superior oblique Z-tenotomy (SOZT) with fixed standard SOZT in canceling preoperative superior oblique overaction associated with A pattern anisotropia or V pattern in Brown's syndrome. PATIENTS AND METHODS: Sixteen consecutive patients with superior oblique overaction or Brown's syndrome were treated by removal of a triangular piece of the superior oblique tendon near its insertion (augmented SOZT). Outcome was compared with 20 consecutive historical controls after standard SOZT. RESULTS: The decrease in superior oblique overaction in the right and left eyes and fundus intorsion and the collapse of A pattern anisotropia were more significant for patients with superior oblique overaction (P = .003, P = .007, P = .05, P = .0015, respectively) and patients with Brown's syndrome (P = .025, P = .03, and P = .05, respectively). No study patient with superior oblique overaction and A pattern anisotropia required reoperation compared with 5 of 14 controls (37.5%); rates for patients with Brown's syndrome were 0 for the study group and 3 of 6 (50%) for the control group. CONCLUSIONS: Augmented SOZT is superior to standard SOZT for correcting superior oblique overaction, intorsion, A or V pattern, and stereopsis. It is not associated with complications or reoperation. The size of the Z-tenotomy can be modified according to the intraoperative assessment to achieve symmetric results.

Treatment considerations for primary uveal melanoma with choroidal metastasis to the fellow eye.

We report two cases of primary uveal melanoma with metastatic involvement of the contralateral eye. Two female patients presented with primary choroidal melanoma. In the first case, primary enucleation of the affected eye was performed. Two years later, systemic tumor spread with contralateral choroidal melanoma was detected. A decision for observation of the ocular metastasis was made. In the second case, systemic tumor spread was already evident at time of initial diagnosis of the ocular melanoma. Six months later, a choroidal metastasis was detected in the fellow eye. Again, observation was recommended. In conclusion, systemic spread of primary choroidal melanoma may include a choroidal metastasis to the contralateral eye. Observation of the second affected eye may be prescribed.

Familial exudative vitreoretinopathy and macular hole exhibited in same individual.

This observational case report is designed to report the first known occurrence of Familial Exudative Vitreoretinopathy (FEVR) and macular hole in the same individual. Clinical exams and fluorescein angiography were used to evaluate patient. Indirect laser panretinal photocoagulation was used to treat the right eye. A nine-year old male was diagnosed with familial exudative vitreoretinopathy in both eyes, as well as a full-thickness macular hole in his right eye. Medical histories indicated that the macular hole was not caused by trauma. Indirect laser panretinal photocoagulation was performed to treat an exudative process caused by FEVR in the right eye, and the exudative retinal detachment regressed. A vitrectomy was later also performed to treat traction retinal detachment as well as macular hole in the right eye. Our conclusion is that macular hole can be associated with familial exudative vitreoretinopathy.

Intravitreous vascular endothelial growth factor (VEGF) inhibitor therapy for tamoxifen induced macular edema.

A 59-year-old male patient with tamoxifen induced macular edema in both eyes was treated with intravitreous sodium pegaptanib. Follow-up clinical examination, OCT, and FA demonstrated reduced edema and leakage with improvement in visual acuity.

Insulinlike growth factor I affects ocular development: a study of untreated and treated patients with Laron syndrome.

OBJECTIVE: To evaluate the ocular dimensions in patients with primary growth hormone receptor insensitivity (Laron syndrome [LS]) and to study the effect of supplemental insulinlike growth factor I (IGF-I) on ocular growth. DESIGN: Retrospective case series. PARTICIPANTS: Twelve patients with LS, 8 untreated (LS group) and 4 treated (LS-T group) with supplemental IGF-I, and 30 healthy controls. METHODS: Ocular dimensions and refraction were measured, and a full ophthalmologic examination was performed. MAIN OUTCOME MEASURES: Differences in the average ocular dimension data among IGF-I-treated patients, untreated ones, and controls. RESULTS: The average axial length of eyes in the LS group was 21.94 mm (standard deviation [SD], 0.81). Corresponding values for the LS-T and control group eyes were 22.53 mm (SD, 1.74) and 23.20 mm (SD, 1.35) respectively. The average anterior chamber depth of eyes in the LS group was 2.55 mm (SD, 0.26). Corresponding values for eyes in the LS-T and control groups were 3.48 mm (SD, 0.09) and 3.84 mm (SD, 0.16) respectively. The average lens thickness of eyes in the LS group was 4.56 mm (SD, 0.36). Corresponding values for the LS-T and control groups were 3.77 mm (SD, 0.23) and 3.51 mm (SD, 0.25), respectively. The average corneal curvature of eyes in the LS group was 46.9 diopters (D) (SD, 2.32). Corresponding values for the LS-T and control groups were 47.6 D (SD, 2.83) and 44.4 D (SD, 1.5), respectively. CONCLUSIONS: Insulinlike growth factor I seems to be an important regulator of ocular growth as documented in patients with primary growth hormone insensitivity. The mechanism of this observation should be investigated further.

Age-related macular degeneration: a practical approach to a challenging disease.

Age-related macular degeneration (AMD) is the leading cause of blindness in older North Americans. The clinical spectrum, risk factors, pathophysiology, and potential therapeutic options for AMD warrant a careful review. Despite the growth in treatment options for this disease, there is no current curative therapy. Of critical importance is attention to modifiable risk factors--improvements in cardiovascular status, including smoking cessation, and routine ophthalmic monitoring for opportunities to provide early intervention. In addition, a low-vision assessment to investigate the potential use of visual assistive devices may be beneficial to any patient who has experienced a decrease in vision. Finally, education regarding the clinical course of age-related macular degeneration and accurate information with respect to the known benefits of available treatments will impart a better understanding of this disease to patients.

Endocrine effects on the growth, development and function of the eye.

A cohort of hormonal signals affects the function of the eye in providing eyesight. From the early days of growth, endocrine mechanisms guide the young eye's development. Later on in life, hormonal interactions play an important role in maintaining proper vision and continue to affect the eyes in pregnancy, as well as in aging. The purpose of this article is to review the effects of the endocrine system on the eye. Current knowledge about hormonal interactions that play a role in the growth and development of the eye will be discussed separately for each of the hormones known to be involved.

Scleral Cross-linking Using Riboflavin and Ultraviolet-A Radiation for Prevention of Axial Myopia in a Rabbit Model.

Myopic individuals, especially those with severe myopia, are at higher-than-normal risk of cataract, glaucoma, retinal detachment and chorioretinal abnormalities. In addition, pathological myopia is a common irreversible cause of visual impairment and blindness. Our study demonstrates the effect of scleral crosslinking using riboflavin and ultraviolet-A radiation on the development of axial myopia in a rabbit model. The axial length of the eyeball was measured by A-scan ultrasound in New Zealand white rabbits aged 13 days (male and female). The eye then underwent 360° conjunctival peritomy with scleral crosslinking, followed by tarsorrhaphy. Axial elongation was induced in 13 day-old New Zealand rabbits by suturing their right eye eyelids (tarsorrhaphy). The eyes were divided into quadrants, and every quadrant had two scleral irradiation zones, each with an area of 0.2 cm² and a radius of 4 mm. Crosslinking was performed by dropping 0.1% dextran-free riboflavin-5-phosphate onto the irradiation zones 20 sec before ultraviolet-A irradiation and every 20 sec during the 200 sec irradiation time. UVA radiation (370 nm) was applied perpendicular to the sclera at 57 mW/cm² (total UVA light dose, 57 J/cm²). Tarsorrhaphies were removed on day 55, followed by repeated axial length measurements. This study demonstrates that scleral crosslinking with riboflavin and ultraviolet-A radiation effectively prevents occlusion-induced axial elongation in a rabbit model.

Ocular growth in premature infants conceived by in vitro fertilization versus natural conception.

PURPOSE: To evaluate the possible effect of in vitro fertilization (IVF) on early development of the eye in premature infants. METHODS: Biometric and keratometric values, intraocular pressure, and retinal vascular status were assessed in a cohort of 133 premature infants. These values were compared between premature infants conceived by IVF or naturally, and the relationship between these parameters and postconceptional age and weight at examination were evaluated. RESULTS: The sample consisted of 133 premature infants, 62 (46.6%) born by IVF and 71 (53.4%) by natural conception. Postconceptional age at examination was 28 to 46 weeks. In both groups, axial length, anterior chamber depth, and corneal radius correlated with the postconceptional age and weight at examination and followed a linear growth pattern. Lens thickness changed very slightly. The rate of retinal vascularization correlated with the postconceptional age as well. No correlation was found between intraocular pressure and corrected age or weight at examination. There was no difference between the study and control groups in any of the biometric or keratometric parameters or in intraocular pressure, according to two-way analysis of variance. CONCLUSIONS: IVF apparently does not affect early ocular growth, intraocular pressure, changes in corneal curvature, or retinal vascularization in premature infants. These findings may aid ophthalmologists in assessing ocular dimensions in this patient population.

Combined rectus muscle transposition with posterior fixation sutures for the treatment of double-elevator palsy.

PURPOSE: To evaluate the surgical and functional results of full horizontal tendon rectus muscle transposition to the superior rectus (SR) insertion, augmented by posterior fixation sutures, in patients with double-elevator palsy (DEP). DESIGN: Retrospective nonconcurrent interventional comparative case series. PARTICIPANTS: Fourteen consecutive patients with DEP. INTERVENTION: Six patients treated for DEP by vertical transposition of the horizontal muscles to the SR insertion (Knapp procedure) were compared with 8 patients treated by the Knapp procedure combined with fixation of the transposed muscles to the sclera, adjacent to the SR, with nonabsorbable sutures. MAIN OUTCOME MEASURES: Postoperative ocular alignment, ductions, binocular functions, and rate of reoperation. RESULTS: Ocular deviation: Mean distance and near deviations decreased by 84% and 83%, respectively (P = 0.012), in the augmented-surgery group versus 48% and 47%, respectively (P = 0.03), in the standard-surgery group. Duction: Mean elevation deficiency in abduction and adduction improved by 64% and 65%, respectively (P = 0.01), in the augmented surgery group versus 42% and 55% (P = 0.02) in the standard group. Binocular functions: 3 patients (37%), all in the study group, gained binocular function. Reoperation was required in 5 patients (83.3%) in the control group. The difference in postoperative improvement between the groups was statistically significant for all 4 parameters. No postoperative complications or duction anomalies were observed during the follow-up period of 15.4 months (standard deviation, 5.5). CONCLUSIONS: The augmented Knapp procedure with superior posterior fixation suture is the preferred surgical treatment for patients with DEP. Its use in this series avoided the need for multiple surgeries on other extraocular muscles.

Airbag-induced bilateral corneal graft dehiscence.

PURPOSE: To report a case of bilateral corneal graft dehiscence caused by blunt trauma. METHODS: Case report of bilateral simultaneous corneal graft dehiscence with expulsion of the lens and iris as a result of airbag-induced trauma. RESULTS: Both corneal buttons were resutured, the prolapsed iris tissue was repositioned in the right eye, and anterior vitrectomy was performed bilaterally. Topical and systemic antibiotics, topical steroids, cycloplegic agents, and antiglaucoma drugs were initiated. Repeated B-scan ultrasound examinations demonstrated an attached retina in both eyes. Three weeks after admission, the right eye was reoperated for removal of remnant lens material and additional anterior vitrectomy. The patient was fitted with polycarbonate spectacles with an optical correction of +8 in both eyes. Visual acuity improved to 20/200 and 0.5/60 in the right and left eyes, respectively. The right corneal graft regained transparency, but the left one remained hazy. CONCLUSION: Airbag deployment during motor vehicle collisions is a significant cause of ocular morbidity. The reported risk of airbag-related eye injury is 2.5% for any eye injury and 0.4% for severe eye injury. Patients undergoing corneal surgery should be counseled about the weakness of the donor-recipient interface and should consider wearing protective glasses.

Intraocular pressure variations after diode laser photocoagulation for threshold retinopathy of prematurity.

PURPOSE: To investigate the intraocular pressure (IOP) variations occurring after indirect diode laser photocoagulation for threshold retinopathy of prematurity. DESIGN: Prospective, nonrandomized, comparative study. PARTICIPANTS: A study group-21 consecutive premature babies (42 eyes) undergoing diode laser photocoagulation for retinopathy of prematurity-and control groups-32 premature babies (64 eyes) undergoing retinal examination with or without scleral indentation. INTERVENTION: Intraocular pressure was measured with a portable electronic tonometer before, immediately after, and 1, 2, and 3 days after diode laser photocoagulation in the study group; before retinal examination in control group 1; and before and after retinal examination with scleral indentation in control group 2. MAIN OUTCOME MEASURE: Intraocular pressure after diode laser photocoagulation for threshold retinopathy of prematurity. RESULTS: Mean IOP in the study group rose from 15 mmHg (standard deviation [SD] = 4.1) before coagulation to 33.2 mmHg (SD = 7.8; range, 20-50) immediately after, and then dropped to 22.2 (SD = 5.2), 16.5 (SD = 3), and 14.5 mmHg (SD = 2.1) 1, 2, and 3 days later, respectively. All the changes were statistically significant at P<0.0001, except for the difference between days 2 and 3 (P = 0.096). Mean baseline IOPs were 16.3 mmHg (SD = 3.7) in control group 1 and 15.7 mmHg (SD = 2.3) in control group 2 (P = 0.84 between control group 1 and study group, and P = 0.32 between control group 2 and the study group). At termination of the retinal examination with scleral indentation (control group 2), IOP measured 15.1 mmHg (SD = 2.2) (P = 0.49 compared with baseline). CONCLUSIONS: Intraocular pressure may be significantly elevated after diode laser photocoagulation for retinopathy of prematurity. The mechanism and long-term clinical implications of this observation should be investigated.

Quantitative changes in botulinum toxin a treatment over time in patients with essential blepharospasm and idiopathic hemifacial spasm.

PURPOSE: To evaluate the quantitative changes in botulinum toxin A (BTA) treatment required over time to achieve relief for 3 to 4 months in patients with essential blepharospasm (EBS) and idiopathic hemifacial spasm (IHFS). DESIGN: Interventional case series. METHODS: In this retrospective longitudinal study in an institutional ophthalmologic outpatient clinic, data were retrieved from patient files and a comparison between patients with EBS and IHFS was performed. The patient population consisted of 27 patients, 17 with EBS and 10 with IHFS, who were treated for the first time with BTA injections and were followed up for 4 to 6 consecutive years. All patients initially received 12 or more courses of treatment with a lower dose (20 U). The main outcome measures were the shift in the dose-response relationship between the lower and higher doses and were analyzed with respect to four variables: average number of treatments, dosage, duration of therapy, and interval of symptomatic relief. RESULTS: In the EBS group the mean dose for each patient changed from 16.0 +/- 1.4 U (lower dose) to 24.2 +/- 1.4 U (higher dose). The shift occurred after a mean of 8.8 +/- 2.9 treatments per patient given for a mean of 33.5 +/- 13.3 months. The mean interval of relief was longer with the lower dose than with the higher dose (4.0 +/- 1.4 months vs 3.2 +/- 1.0 months, respectively). In the IHFS group, the mean dose / patient changed from 16.8 +/- 1.2 U to 25.0 +/- 1.8 U, and the switch occurred after a mean of 6.5 +/- 2.3 treatments given over a mean period of 23.8 +/- 6.6 months. The mean duration of treatment with the lower dose was shorter than with the higher dose. The interval of relief was similar for both dose ranges (3.8 +/- 10 months and 4.1 +/- 1.3 months, respectively). The IHFS group switched to the higher dose earlier, by both number and duration of treatments, than the EBS group. Only minor and transient side effects of treatment were observed in both groups. CONCLUSIONS: Botulinum toxin A is an effective and safe treatment for EBS and IHFS. The dose in our study was increased over time by 50% to achieve 3 to 4 months of symptomatic relief with minimal complications.

Association of neovascular age-related macular degeneration and hyperhomocysteinemia.

PURPOSE: To assess the relationship between plasma homocysteine levels and exudative neovascular age-related macular degeneration (AMD). DESIGN: Cross-sectional study. METHODS: A prospective comparative cross-sectional study was conducted in outpatient ophthalmology clinics in a university-affiliated medical institution. The cohort consisted of 59 patients (25 male, 34 female) with a mean age of 78 years (standard deviation [SD] = 8.4) with neovascular AMD who were candidates for photodynamic treatment. Patients were compared for plasma homocysteine levels with 58 patients who had dry AMD (24 male, 34 female) with a mean age of 76.3 years (SD = 8.4) and with a control group of 56 age-matched subjects (27 male, 29 female), with a mean age of 77.3 years (SD = 8.2). A 3-ml venous blood sample was obtained from each participant after an 8-hour fast. Levels of plasma homocysteine were measured by high performance liquid chromatography. The main outcome measure was hyperhomocysteinemia, defined as a plasma homocysteine level above 15 micromol/l. RESULTS: Homocysteine levels were higher by 27.9% in the neovascular AMD than in the dry AMD group, and by 21.9% than in the control group (P <.02). Hyperhomocysteinemia was found in 44.1% of the study group, in 22.4% of the dry AMD group, and in 21.4% of the control group (P =.011). CONCLUSIONS: This study suggests an association between an elevated plasma level of homocysteine and exudative neovascular AMD but not dry AMD.

Novel 'heavy' dyes for retinal membrane staining during macular surgery: multicenter clinical assessment.

PURPOSE: To evaluate the feasibility of two novel 'heavy' dye solutions for staining the internal limiting membrane (ILM) and epiretinal membranes (ERMs), without the need for a prior fluid-air exchange, during macular surgery. METHODS: In this prospective nonrandomized multicenter cohort study, the high molecular weight dyes ILM-Blue™ [0.025% brilliant blue G, 4% polyethylene glycol (PEG)] and MembraneBlue-Dual™ (0.15% trypan blue, 0.025% brilliant blue G, 4% PEG) were randomly used in vitrectomy surgeries for macular disease in 127 eyes of 127 patients. Dye enhanced membrane visualization of the ILM and ERMs, 'ease of membrane peeling', visually detectable perioperative retinal damage, postoperative best-corrected visual acuity (BCVA), dye remnants and other unexpected clinical events were documented by 21 surgeons. RESULTS: All surgeries were uneventful, and a clear bluish staining, facilitating the identification, delineation and removal of the ILM and ERMs, was reported in all but five cases. None of the surgeries required a fluid-air exchange to assist the dye application. BCVA at 1 month after surgery improved in 83% of the eyes in the MembraneBlue-Dual™ group and in 88% in the ILM-Blue™ group. No dye remnants were detected by ophthalmoscopy, and no retinal adverse effects related to the surgery or use of the dyes were observed. CONCLUSION: The 'heavy' dye solutions ILM-Blue™ and MembraneBlue-Dual™ can be injected into a fluid-filled vitreous cavity and may facilitate staining and removal of the ILM and/or ERMs in macular surgery without an additional fluid-air exchange.