Copyright
©The Author(s) 2026. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2026; 14(4): 117314
Published online Feb 6, 2026. doi: 10.12998/wjcc.v14.i4.117314
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, Prathibha Hande, Pragati Raj, Karishma Tendulkar, Vishma Prabhu, De
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. 1st 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
Revised: December 19, 2025
Accepted: January 19, 2026
Published online: February 6, 2026
Processing time: 63 Days and 6.9 Hours
Core Tip
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.