Presumed Combined Brilliant Blue G and Endolight-Induced Macular Damage following Epiretinal Membrane Removal Surgery

PURPOSE: To report a rare case of macular outer retinal and retinal pigment epithelium (RPE) damage following brilliant blue G (BBG)-assisted epiretinal membrane (ERM) removal surgery. METHODS: Retrospective, observational case report. RESULTS: An 85-year-old lady presented with decreased vision in the left eye and a best-corrected visual acuity of 20/400. The right eye examination was within normal limits. The left eye had a significant cataract, and the fundus examination through the cataractous haze showed an ERM with macular pucker, which was confirmed on an optical coherence tomography (OCT) scan. A combined cataract surgery with intraocular lens implantation and BBG-assisted ERM removal and internal limiting membrane peeling surgery was performed. Over the subsequent visits, a well-defined area of outer retinal and RPE alteration was identified on OCT and fundus autofluorescence without significant improvement in visual acuity. At the last follow-up visit, the visual acuity minimally improved to 20/200. CONCLUSIONS: Macular toxicity due to repeated usage of BBG dye and high intensity focal endo-illumination may lead to poor visual outcome following ERM removal or similar macular surgeries. Adequate precautions need to be taken to prevent vision loss.