Membrane Peeling Procedure With Dye May Limit Epiretinal Membrane Recurrence

Retinal Detachment, Surgery
Ophthalmology surgery, Pasteur 2 Hospital, Nice, France, treatment of a retinal detachment through vitrectomy, The doctor is helped by the intern. (Photo by: BSIP/Universal Images Group via Getty Images)
Internal limiting membrane peeling with Brilliant Blue G dye may prevent another surgery for epiretinal membrane recurrence, a study suggests.

Epiretinal membrane (ERM) fragments may be responsible for recurrent ERMs following pars plana vitrectomy (PPV), according to a study published in the Canadian Journal of Ophthalmology. Internal limiting membrane (ILM) peeling with Brilliant Blue G (BBG) dye may prevent growth of a residual ERM, according to the report.  

Researchers retrospectively reviewed 195 eyes from 195 patients with ERMs who underwent PPV between May 2016 and May 2018 (mean age 72±0.7 years, 124 women). They assigned patients to groups consisting of individuals who underwent ILM removal without BBG dye (group 1, 87 eyes) and those who received BBG dye treatment (group 2, 108 eyes). The team obtained optical coherence tomography (OCT) images during a 3 day and 3 year follow-up.

At 3-day follow-up, OCT imaging revealed ERM fragments with retinal surface wrinkling in 53 eyes (27.2%) and retinal surface wrinkling without EMR in 9 eyes (4.6%). The 3-year postoperative analysis identified ERMs in 63 eyes (32.3%), 62 of which showed an ERM fragment, retinal surface wrinkling, or both on OCT image during the 3-day follow-up. 

Residual ERM grew in 20 (64.5%) of the 31 eyes with residual ERM in group 1, and 5 (22.7%) of the 22 eyes with residual ERM in group 2, revealing a statistically significant difference in growth rates (P =.003).

“ERM fragments may be the source of recurrent ERMs after PPV, and ILM peeling assisted with BBG dye may prevent growth of residual ERM,” according to the researchers. “Eliminating ERM and ILM fragments intraoperatively may effectively reduce another surgery for ERM peeling.”

Study limitations include the retrospective nature and high loss to follow up (12.7%).  


Hikichi T, Kubo N, Tabata M. Epiretinal membrane fragments: the origin of recurrent membranes after epiretinal membrane peeling. Can J Ophthalmol.  Published online June 16, 2022. doi:10.1016/j.jcjo.2022.04.006