Vital dyes for membranes stain

Vital dyes for membrane’s stain can be dived into a few groups:

-The dyes that can be used to identify both epiretinal and internal limiting membranes (e.g. triamcinolone particles, membrane blue-dual)

-The dyes that can identify only the epiretinal membrane (e.g. trypan blue)

-The dyes that can identify the internal limiting membrane (e.g. Brilliant blue G, Indocyanine green)

Magnification for membrane peel

All the lenses for membrane peel could be divided into two categories:

- non-contact (e.g. 128D & 60D lenses of the Resight system)

- contact lenses (e.g. different types of macula lenses)

Advantages of non-contact viewing system compare to contact one:

- No-touch ( it means that this lens will not create distortions like corneal folds)

- Good visualization through the small pupil

- Larger field of view 

Disadvantages of non-contact viewing system:

- Conditions characterized by corneal asphericity (e.g. keratoconus) can decrease the quality of the image resolution

- Decreased stereoscopic view of the image

NB! Non-contact lenses require the use of long-lasting topical lubricant for cornea (for example hydroxyethylcellulose)  preventing its drying out and reducing corneal aberrations.

Advantages of contact viewing system compare to non-contact one:

- Amazing magnification of the macula with a clear view of the details

Disadvantages of contact viewing system:

- Decreased field of view (it is crucial to remain aware of the position of the instruments)

Instruments for membrane peel

- Probably the most common instrument used for membrane peel are forceps.

• Different designs and materials of forceps are available. Depending on the tip and grasping surface designs, forceps can be divided into end gripping, asymmetric end gripping, serrated gripping, angled gripping, and others. Also, forceps can be diamond-coated and non-coated.

• Parallel to the retina direction of the forces during the peeling prevents an early amputation of the flap.

  Peripheral regrasping of the flap helps to avoid accidental foveal damage. During grasping the membrane, especially at the beginning of the peeling when no elevated flap still exists, essential to make sure that no underlying retinal tissue was grasped together with a membrane to prevent pulling the retina up and iatrogenic retinal breaks.

- Tano or diamond-dusted membrane scraper is a popular instrument used to initiate the peeling in patients with very adherent membranes or elevate the membrane edge.

This instrument does not allow total peeling of the membrane therefore, should be used in conjunction with forceps.

- Other instruments that can be used to create an initial flap are a flex loop, retinal pick, and MVR blade