Retinal architecture as a determinant of brilliant blue G phototoxicity during internal limiting membrane peeling: A case series

doi:10.12998/wjcc.v14.i4.117314

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 14, Issue 4

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (74)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-3) series, Tables (1-1) series.

Item

Count

PDF

HTML

Figures (1-3)

Tables (1-1)

Sum=33

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

Sum=19

Feb 6, 2026 (publication date) through Feb 11, 2026

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Clinical Cases

ISSN

2307-8960

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Control Study

World J Clin Cases. Feb 6, 2026; 14(4): 117314
Published online Feb 6, 2026. doi: 10.12998/wjcc.v14.i4.117314

Retinal architecture as a determinant of brilliant blue G phototoxicity during internal limiting membrane peeling: A case series

Ramesh Venkatesh, Edwin James, Prathibha Hande, Pragati Raj, Karishma Tendulkar, Vishma Prabhu

Ramesh Venkatesh, Prathibha Hande, Pragati Raj, Karishma Tendulkar, Vishma Prabhu, Department of Ophthalmology, Narayana Nethralaya, Bangalore 560010, India

Edwin James, Department of Ophthalmology, Government Medical College Kollam, Kollam 691574, Kerala, India

Co-first authors: Ramesh Venkatesh and Prathibha Hande.

Author contributions: Venkatesh R and Hande P were responsible for the clinical management of the cases and analyzing the cases, drafting and finalizing the manuscript; James E was responsible for the critical review of the manuscript; Prabhu V, Tendulkar K, and Raj P were responsible for data acquisition and image collection.

Institutional review board statement: This study was conducted in accordance with the tenets of the Declaration of Helsinki. Institutional ethics committee approval was obtained from the Narayana Nethralaya Ethics Committee, Bangalore, India (EC Ref. No: C/2019/03/04). Given the retrospective nature of the study and the use of anonymized clinical data, the requirement for informed patient consent was waived by the Ethics Committee.

Informed consent statement: Informed consent was waived by the Institutional Ethics Committee due to the retrospective design of the study and the use of de-identified patient data with no direct patient involvement.

Conflict-of-interest statement: All authors declare that they have no conflicts of interest relevant to this study.

STROBE statement: The authors have read the STROBE statement-checklist of items, and the manuscript was prepared and revised according to the STROBE statement-checklist of items.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request, subject to institutional and ethical regulations.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Ramesh Venkatesh, MBBS, Consultant, Department of Ophthalmology, Narayana Nethralaya, 121/C. 1^st R block, West of Chord Road, Rajaji Nagar, Bangalore 560010, India. vramesh80@yahoo.com

Received: December 4, 2025
Revised: December 19, 2025
Accepted: January 19, 2026
Published online: February 6, 2026
Processing time: 63 Days and 6.9 Hours

Abstract

BACKGROUND

Chromovitrectomy using vital dyes has become integral to internal limiting membrane (ILM) peeling in macular surgery. Although brilliant blue G (BBG) is considered safer than earlier dyes, emerging clinical and experimental evidence suggests that dye-light interactions during surgery may result in retinal phototoxicity under specific conditions.

AIM

To describe the retinal phototoxicity features associated with BBG dye in patients undergoing ILM peeling for macular surgeries.

METHODS

This observational, comparative, retrospective case series analyzed 9 eyes of 9 patients demonstrating retinal phototoxicity after uneventful BBG-assisted ILM peeling. Surgical indications included full-thickness macular hole (MH) in 4 eyes, epiretinal membrane associated retinal traction in 4 eyes, and vitreomacular traction in 1 eye. Retinal phototoxicity was assessed during clinical examination, using optical coherence tomography, and fundus autofluorescence imaging. Parameters such as preoperative and postoperative visual acuity (VA), macular thickness, BBG exposure characteristics (single/repeated staining, exposure duration, staining medium), and follow-up outcomes were recorded. Cases were grouped based on surgical indications: Group A (MH, 4 eyes) and group B (non-MH, 5 eyes).

RESULTS

In group A, all cases showed foveal phototoxic damage along with macular involvement despite successful MH closure. Two eyes experienced worsened VA, while the other two maintained baseline VA. In group B, phototoxicity involved the macular region but spared the fovea; VA improved in 3 eyes (60%) and was maintained in 2 eyes (40%). Retinal toxicity, characterized by photoreceptor and retinal pigment epithelium damage, was evident within 1-4 weeks postoperatively.

CONCLUSION

BBG-related retinal phototoxicity may occur following ILM peeling, with eyes undergoing MH surgery appearing more vulnerable, possibly due to the absence of protective foveal neurosensory tissue. Awareness of this potential risk may encourage surgeons to consider minimizing illumination intensity and dye exposure, and to adopt protective intraoperative strategies aimed at preserving foveal integrity and optimizing visual outcomes.

Keywords: Retinal toxicity; Brilliant blue G; Endo illumination; Outcome; Fovea

Core Tip: This case series identifies retinal architecture as a key determinant of brilliant blue G (BBG)-related toxicity during internal limiting membrane peeling. Phototoxicity was more severe in macular hole (MH) cases where the exposed retinal pigment epithelium allowed direct BBG-light interaction, leading to foveal damage and poor visual recovery. Non-MH eyes, including epiretinal membrane and vitreomacular traction, retained foveal protection and demonstrated better postoperative vision. The study reinforces careful control of illumination and BBG exposure in MH surgery.