Biography/Disclosures
Biography: Singh is a staff surgeon at the Cole Eye Institute, Cleveland Clinic and Associate Professor of Ophthalmology at the Lerner College of Medicine in Cleveland Ohio. He also currently serves as the medical director of informatics at the Cleveland Clinic.
Disclosures: Singh reports he is a consultant to Zeiss, Novartis, Regeneron, Genentech and Alcon and receives grant support from Apellis and Graybug.
July 31, 2020
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BLOG: First impressions of Brilliant Blue

Biography/Disclosures
Biography: Singh is a staff surgeon at the Cole Eye Institute, Cleveland Clinic and Associate Professor of Ophthalmology at the Lerner College of Medicine in Cleveland Ohio. He also currently serves as the medical director of informatics at the Cleveland Clinic.
Disclosures: Singh reports he is a consultant to Zeiss, Novartis, Regeneron, Genentech and Alcon and receives grant support from Apellis and Graybug.
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The removal of the internal limiting membrane during vitreoretinal surgery has become standard of care, especially in macular hole surgery.

Also, many surgeons use vital stains to counterstain the internal limiting membrane (ILM) when trying to identify epiretinal membrane (ERM) tissue.

While the vast majority of U.S. retina specialists had used indocyanine green (ICG) in the past in an off-label manner, concerns around ocular toxicity, lack of a continuous supply and the need for mixing the drug before use have been reasons why other dyes are needed.

Rishi P. Singh, MD

Brilliant Blue has been used in Europe and Asia for years with a good efficacy and safety record. Tissue Blue (Brilliant Blue G ophthalmic solution, DORC) was recently approved by the FDA for staining the ILM. It comes as a premixed solution to remove the variable of incorrectly mixing, which could have occurred with ICG. Here is a link to two cases in which I used Brilliant Blue for the first time: www.youtube.com/watch?v=Feeoo-h9Jpw.
Tissue Blue did a very nice job staining the ILM in the setting of a macular hole without significant epiretinal membrane tissue. When counterstaining for the ERM, it was less than adequate at identifying the peripheral ILM tissue to begin the peel. The solution comes premixed, which increases the ability to open quickly for a case, but it lacks the 5% dextrose that would be typically in ICG, so it does not sit as well on the fovea. To get the correct amount of stain of the ILM, I’ve increased my staining period to 1 minute from the typical 30 seconds I’ve used for ICG in the past. And from a cost perspective, it is near equivalent to ICG at our institution. I would love to hear your perspectives on this new product.

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