Efficacy and Safety Profile of Vital Dyes

Vital dyesVital dyes represent important intraoperative tools in vitreoretinal surgeryVitreoretinal surgery due to their ability to stain different intraocular structures and, thus, facilitate several surgical maneuvers, including removal of the vitreous and peeling of epiretinal membraneEpiretinal membrane and internal limiting membraneInternal Limiting Membrane (ILM). The chemical structure of these compounds determines their protein binding affinity and, thus, the staining properties. From a surgical point of view, vital dyesVital dyes are commonly divided in dyes for the vitreous (triamcinoloneTriamcinolone acetonide and lutein-based vitreous dye) and dyes for the vitreoretinal interface (cyanine dyes, blue dyesBlue dyes and lutein-based dyesLutein-based dyes). Despite the established advantages deriving from performing pars plana vitrectomyPars plana vitrectomy with the aid of vital dyesVital dyes (chromovitrectomyChromovitrectomy), several reports documented the potential intraocular toxicity of these compounds, mainly in form of progressive outer retinal layers disruption and atrophic changes of the retinal pigment epithelium. Multiple regulations are currently aimed to ensure the safety of intraocular medical devicesMedical devices, including vital dyesVital dyes, and, in this regard, in vitro cytotoxicity tests play a crucial role in assessing the biocompatibility of these compounds. The aim of this chapter is to provide an overview of the main vital dyesVital dyes currently available in terms of physicochemical characteristics, staining properties, clinical use and outcomes, evidence of safety from experimental studies and potential intraocular toxicity. In particular, with regard to the dye-related retinal toxicity, we will focus on the common clinical findings and surgical details of the cases reported.