Diffuse retinal pigment epithelium atrophy following pars plana vitrectomy for high myopic macular hole assisted by Brilliant Blue G: A case report

PURPOSE: To describe a case of diffuse retinal pigment epithelium (RPE) disturbance following 23-gauge pars plana vitrectomy (PPV) with the inverted internal limiting membrane (ILM) technique and Brilliant Blue staining for a high myopic macular hole (MH). OBSERVATIONS: A 53-year-old pseudophakic high myopic female was referred to the Vitreoretinal Department with a diagnosis of a full thickness myopic MH of her right eye. Her initial visual acuity was 20/40 of her right eye and 20/20 in the left eye. She underwent routine PPV with inverted ILM flap assisted by repeated brilliant blue staining. Surgery was uneventful without any intraoperative complications. MH closure was obtained within the first days. Three weeks postoperatively, the patient reported a decline in visual acuity of her right eye. Upon examination, her visual acuity decreased to 20/400. Fundus examination showed diffuse pigmentary changes with mottling at the level of the RPE, which later progressed to severe diffuse atrophy, as confirmed by fundus autofluorescence (FAF). After 12 months, visual acuity remained 20/400 with widespread areas of atrophy. CONCLUSIONS: Uncomplicated routinary PPV assisted with Brilliant Blue, can lead to unexplained atrophy of the RPE. Possible causes include light phototoxicity, dye toxicity or both.