Title: Functional and Anatomical Outcomes after Brilliant Blue G vs. Indocyanine Green-Assisted ILM Peeling in Macular Hole Surgery: A Meta-analysis

Background: Internal limiting membrane (ILM) peeling is a critical step in macular hole surgery, with vital dyes such as Brilliant Blue G (BBG) and Indocyanine Green (ICG) commonly used to enhance visualization. While both dyes facilitate ILM removal, their comparative impact on postoperative visual acuity remains uncertain.

Objectives: To evaluate the proportion of eyes achieving visual acuity improvement and macular hole closure following BBG- versus ICG-assisted ILM peeling in patients undergoing macular hole surgery.

Methods: A systematic search of PubMed, Scopus, and Embase was conducted from inception to September 2025 to identify studies comparing Brilliant Blue G and Indocyanine Green-assisted ILM peeling in macular hole surgery. Pooled estimates were calculated using random-effects models, reporting odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Statistical heterogeneity was assessed using I² and χ² statistics. All analyses were performed using RevMan 5.4, and p-values <0.05 were considered statistically significant.

Results: Four studies met the inclusion criteria, encompassing 206 eyes (BBG = 81; ICG = 125). The pooled analysis revealed no significant difference in visual acuity improvement between BBG and ICG (MD = –0.05, 95% CI: –0.21 to 0.11; P = 0.55; I² = 82%). Additionally, two studies reported macular hole closure rates, showing no statistically significant difference between the two dyes (OR = 2.37, 95% CI: 0.25 to 22.58; P = 0.45; I² = 0%).

Conclusion: Brilliant Blue G and Indocyanine Green provide comparable functional and anatomical outcomes following ILM peeling in macular hole surgery. This study demonstrated no significant differences in postoperative visual acuity improvement or macular hole closure rates between the two dyes. It suggest that either dye can be effectively used to facilitate ILM peeling, though further high-quality studies are needed to confirm long-term visual and anatomical results.