Accidental Subretinal Brilliant Blue G Migration During Internal Limiting Membrane Peeling Surgery | Emergency Medicine | JAMA Ophthalmology | JAMA Network
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Subretinal brilliant blue G

Epiretinal membrane and internal limiting membrane peeling; note the presence of brilliant blue G under the retina.

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Brief Report
January 2015

Accidental Subretinal Brilliant Blue G Migration During Internal Limiting Membrane Peeling Surgery

Author Affiliations
  • 1Department of Ophthalmology, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
  • 2Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
  • 3Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
JAMA Ophthalmol. 2015;133(1):85-88. doi:10.1001/jamaophthalmol.2014.3869

Importance  This case report describes a man who developed retinal changes in his right eye associated with brilliant blue G migration into the subretinal space during 2 years of follow-up.

Observation  The patient’s best-corrected visual acuity in the right eye was 20/70 before surgery, and it improved to 20/25 at 1 year after surgery. Fluorescein angiography showed staining during the late phase in the central macula at all follow-up visits after surgery. Multifocal electroretinography demonstrated normal amplitude and implicit times before surgery but decreased amplitudes and increased implicit times in at least 5 contiguous hexagons after surgery on all 3 examinations performed during the 2-year follow-up period. These functional changes were not topographically correlated with the area of fluorescein staining or with the internal limiting membrane peeled area, but were matched to the area where brilliant blue G accidentally entered the subretinal space. Microperimetry demonstrated reduced retinal threshold sensitivity, particularly in areas with decreased multifocal electroretinography amplitude.

Conclusions and Relevance  Despite the visual acuity improvement observed in this case, multifocal electroretinography and microperimetry indicate that subretinal brilliant blue G might cause focal macular damage with a decrease of macular function suggestive of a toxic effect.