Manoj Soman¹*, Asmitha Indurkar² Mridula Gnagwar¹ and Unnikrishnan Nair¹

¹Vitreoretinal Services, Chaithanya Eye Hospital & Research Institute, Trivandrum, India
²Cleveland Clinic, Cleveland, OH, USA

*Corresponding Author: Manoj Soman, Vitreoretinal Services, Chaithanya Eye Hospital & Research Institute, Trivandrum, India.

Received: September 10, 2026; Published: September 25, 2026

Abstract

Aim: To report four cases of outer retinal macular phototoxicity following uncomplicated 25-gauge vitrectomy with internal limiting membrane (ILM) peeling, and to investigate the potential pathological role of high intraoperative oxygen levels and choriocapillary loss in this injury.

Methods: A retrospective case series was conducted on four patients (three with idiopathic macular holes and one with an epiretinal membrane) who underwent uncomplicated 25-gauge vitrectomy. Standard surgical safety protocols were strictly followed, including routine operating time, controlled dye contact time, and safe endoilluminator placement. Brilliant blue G (0.05%) was used for ILM staining, and a 20% SF6 gas endotamponade was injected. All patients were intraoperatively exposed to 100% oxygen for 25–30 minutes during the procedure for respiratory insufficiency.

Results: Despite standard intraoperative precautions, all four eyes developed macular phototoxicity characterized by macular degeneration that predominantly affected the outer retina. In one representative case, the retinal degeneration was accompanied by a noticeable loss of the choriocapillaris.

Conclusion: Macular phototoxicity involving the outer retina can occur after vitrectomy even when standard endoillumination and dye precautions are maintained. Intraoperative hyperoxia (100% oxygen delivery) may act as a critical synergistic risk factor that accelerates phototoxic damage. Additionally, choriocapillary loss may play a key role in the underlying pathological process of this unusual complication.

Keywords: Internal Limiting Membrane (ILM); Pigmentation

References

1. Hernández F., et al. “Chromovitrectomy: An update”. Journal of Ophthalmic and Vision Research 9 (2014): 251-259.
2. Sippy BD., et al. “Indocyanine green effect on cultured human retinal pigment epithelial cells: implication for macular hole surgery”. American Journal of Ophthalmology 132 (2001): 433-435.
3. Creuzot-Garcher C., et al. “Functional and structural effect of intravitreal indocyanine green, triamcinolone acetonide, trypan blue, and brilliant blue g on rat retina”. Retina 30 (2010): 1294-1301.
4. Jindal A., et al. “Macular toxicity following brilliant blue G-assisted macular hole surgery - a report of three cases”. Nepal Journal of Ophthalmology11 (2014): 98-101.
5. Venkatesh R., et al. “Combined brilliant blue G and xenon light induced outer retinal layer damage following macular hole surgery”. Indian Journal of Ophthalmology 68 (2020): 247-249.
6. Michels M., et al. “Macular phototoxicity caused by fiberoptic endoillumination during pars plana vitrectomy”. American Journal of Ophthalmology 114 (1992): 287-296.
7. Balaiya S., et al. “Osmolarity and spectrophotometric property of brilliant blue green define the degree of toxicity on retinal pigment epithelial cells exposed to surgical endoilluminator”. Clinical Ophthalmology Auckl NZ 10 (2016): 1543-1551.
8. G J Jaffe., et al. “Retinal Phototoxicity From the Operating Microscope”. The Role of Inspired Oxygen, Ophthalmology8 (1988): 1130-41.
9. Ham WT Jr., et al. “Basic mechanisms underlying the production of photochemical lesions in the mammalian retina”. Current Eye Research 3 (1984): 165-174.
10. Crockett RS and Lawwill T. “Oxygen dependence of damage by 435 nm light in cultured retinal epithelium”. Current Eye Research 3 (1984): 209-215.

Citation

Citation: Manoj Soman., et al. “Brilliant Blue Dye Phototoxicity Accentuated by Intraoperative Oxygen Supplementation". Acta Scientific Ophthalmology 9:10 (2026): 03-06.

Copyright

Copyright: © 2026 Manoj Soman., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.