Severe retinal pigment epitheliopathy following brilliant blue G-assisted epiretinal membrane peeling

To report a case of severe retinal pigment epitheliopathy following 23G pars plana vitrectomy and brilliant blue G (BBG) assisted epiretinal membrane (ERM) peeling in Stage IV primary ERM. Multimodal imaging analyses, including fundus photography, optical coherence tomography, and fundus autofluorescence, were performed to evaluate preoperative and postoperative findings. The patient underwent uneventful pars plana vitrectomy with BBG-assisted ERM peeling with the help of xenon endoilluminator and fine tipped forceps. Six weeks after surgery, the patient complained of paracentral scotomas. On evaluation with retinal imaging, pigmentary alteration was seen over the posterior pole corresponding to the peeled area. A risk of retinal pigment epitheliopathy after uneventful vitrectomy with BBG-assisted ERM peeling is present even with modern endoilluminators. The retinal phototoxicity, use of vital dyes, duration of surgery, stage of ERM preoperatively, and mechanical trauma during peeling may be associated risk factors.