First Author: F.Minaya SPAIN
Co Author(s): L.E. Arellano J. Hernanz V. Molina A. Antón 0 0 0 0 0 0 0 0 0
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To obtain a heavy blue dye (trypan or brilliant blue) by means of adding an exact amount of concentrate glucose to a commercial blue dye for chromovitrectomy. Common dilutions that employ 5% or 10% glucose, particularly reduces dye abilities to adequately stain epiretinal or internal limiting membrane. We thus introduce an innovative, inexpensive, operation theatre custom-made mix of 50% glucose. This heavy dye maintains most of its initial concentration, therefore, enhances visualization within the surgical procedure and complies with safe intraocular osmolarity and glucose concentration.
Department of Ophthalmology Vitreous Retina Macula Unit Segovia General Hospital, Spain. Authors: Francisco Minaya, MD,PhD Luis E. Arellano, MD,MSc,MA Jose Hernanz, MD Veronica Molina, MD Alejandro Antón, MD
We use a 50% glucose vial and extract 0,01 to 0,02 ml with a 1 ml syringe (commonly used insulin or anti-VEGF intravitreal syringe) and a 32 to 30 gauge needle to the commercially available 0,5 ml trypan or brilliant blue solution. This can be done immediately before using the mixture, in sterile conditions, within the operating theatre room. To achieve this solution, we developed a formulae to easily calculate osmolarity and glucose concentration from 50% glucose added volume (or other concentration if required) and compare key values with known dilutions (5% and 10% glucose isovolumetric mixture). We also describe an everyday, simple and fast method to guarantee an accurate, safe operating room procedure.
By adding 0,01 ml of 50% glucose to 0,5 ml of trypan or brilliant blue dye solution (the usual content of a standard dye syringe), glucose concentration is equal to 0,98 g/dl (significantly lower than an isovolumetric mixture of 0,5 ml 5% glucose-0,5 ml dye, 2,5 g/dl) and osmolarity is of 354 mOsm/l (somewhat above standard commercial dye osmolarity, 316 mOsm/l). By adding 50% glucose 0,02 ml to 0,5 ml of dye, glucose concentration is equal to 1,92 g/dl (lower than 0,5 ml 5% glucose + 0,5 ml dye) and osmolarity is of 401 mOsm/l (lower than 0,5 ml 10% glucose + 0,5 ml dye, 431 mOsm/l). Both mixtures descend directly onto the macula without blending with fluid or causing a swirling effect within the vitreous cavity throughout the surgical procedure and usually despite the on-going infusion. This modified dye remains on the posterior pole for as long as the surgeon deems appropriate and it can be easily removed with the aspiration flow safely away from the macula. This novel mixture allows an outstanding visualization for membrane removal. We commonly use this method for membrane staining (both epiretinal and internal limiting membrane) and have not observed any adverse effect.
By adding 0,01 to 0,02 ml of 50% glucose to 0,5 ml of commercial dye, we can obtain a inexpensive, readily available heavy dye for vitreoretinal surgery. This modified dye allows high-quality staining of macular membranes (both epiretinal and internal limiting membrane) without fluid-air exchange, and with no iatrogenic consequences, based on previous scientific literature, calculated proportions and personal experience. The authors consider this innovative method may be useful for vitreoretinal surgeons, surely where commercial heavy dye is not available.