title: Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair.
abstract: OBJECTIVE
  To determine the efficacy and safety of indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling during macular hole repair.
  
  
  METHODS
  Interventional, noncomparative, prospective case series.
  
  
  METHODS
  Twenty-four consecutive patients (24 eyes) with stage 3 or 4 macular holes.
  
  
  METHODS
  All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled into the posterior vitreous cavity over the macula and left in place for 3 to 5 minutes. After removal of the ICG, the retinal ILM was peeled. Medium- to long-acting gas tamponade was used in all cases, and all patients were asked to position face down for 1 to 2 weeks.
  
  
  METHODS
  Intraoperative staining properties of ICG, technical ease of peeling of the retinal ILM, postoperative anatomic results, visual acuity, and complications were recorded.
  
  
  RESULTS
  Indocyanine green stained the retinal ILM, but did not stain the underlying retina. Indocyanine green staining greatly facilitated the surgeons' ability to visualize and peel the ILM in each case. Peeled tissue was sent for both light and electron microscopic studies, which confirmed that the ICG-stained tissue was truly retinal ILM. Patients were observed after surgery for an average of 123 days (range, 23-195 days). Anatomic closure of the macular hole was achieved in 21 eyes (88%) with a single surgery. Visual acuity improved in 23 of 24 patients (96%) after surgery. There were no intra- or postoperative complications related to ICG use, and there was no clinical or fluorescein angiographic evidence of ICG toxicity.
  
  
  CONCLUSIONS
  Indocyanine green stains the retinal ILM. This property facilitates ILM peeling by providing a stark contrast between the stained ILM and the unstained retina. Indocyanine green staining of the ILM appears to be a safe and useful adjunct in vitreous surgery for macular hole repair.
authors: Cincinnati Eye Institute, Cincinnati, Ohio 45242, USA.
authors: A P
authors: AP
authors: Da Mata
authors: S E
authors: SE
authors: Burk
authors: C D
authors: CD
authors: Riemann
authors: R H
authors: RH
authors: Rosa
authors: M E
authors: ME
authors: Snyder
authors: M R
authors: MR
authors: Petersen
authors: R E
authors: RE
authors: Foster
mesh_terms: D000328:Adult; D000368:Aged; D001485:Basement Membrane / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016684:Prone Position; D011446:Prospective Studies; D012167:Retinal Perforations / Q000601:surgery*; D013194:Staining and Labeling / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green