Long-term Follow-up of Acid Violet 17 Damage to the Retinal Pigment Epithelium and Retina after Macular Hole Surgery

Abstract

Background Acid violet 17 (1.5 mg/ml, ala purple) was CE approved as a dye to stain the internal limiting membrane during vitreoretinal interventions. The product was later withdrawn from the market due to safety concerns. This report describes the long-term follow-up in two eyes with obvious toxic effects caused by the dye after macular hole (MH) surgery. Methods The clinical report on pre- and postoperative findings, including SD-OCT, and functional results are presented. Results Preoperative visual acuity (Snellen) was 0.2 p in patient 1 (P1, male 73 years), and 0.1 p in patient 2 (P2, male 78 years). The preoperative horizontal basal diameter of the hole was 1190 µm in P1, and 638 µm in P2. The minimum horizontal diameters of the MHs were 475 µm (P1) and 338 µm (P2). Both MHs were successfully closed. At 10 (P1) and 18 days (P2) after surgery, the patients presented with central destruction of the RPE and associated photoreceptor layer. Visual acuity decreased to hand movements at 2 metres (P1) and 0.05 (P2). In P1, initial swelling of the retinal nerve fibre layer (RNFL) was observed, followed by attenuation to below the preoperative level. In both patients, the central area of degeneration expanded continuously until the end of follow-up (P1: 7.8, P2: 7.25 years). Final visual acuity was 0.05 in P1, and finger counting at 1 metre in P2. Conclusions The cases presented here exemplify the potential severity of acid violet 17 damage after macular hole surgery.

Publication History

Received: 25 September 2023

Accepted: 11 October 2023

Article published online:
23 April 2024

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