title: Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage.
abstract: OBJECTIVE
  To demonstrate possible retinal damage caused by indocyanine green dye for staining of the internal limiting membrane in surgery for idiopathic macular hole.
  
  
  METHODS
  Consecutive interventional case series. We report on the ultrastructural findings of the internal limiting membrane in 10 eyes of 10 patients.
  
  
  RESULTS
  All specimens revealed not only the internal limiting membrane, but also some small amounts of retinal elements, such as the plasma membrane of Müller cells and other undetermined structures. This indicates a cleavage plane not exactly at the inner undulating aspect of the internal limiting membrane but within the innermost retinal layers.
  
  
  CONCLUSIONS
  Dilutions of indocyanine green as recommended in the literature may alter the structure of the retina to some degree. Possible factors responsible for this inadvertent action may include (1) concentration, (2) osmolarity pH, (3) time of tissue contact, and (4) mechanical factors from more forceful traction during peeling. Although functional consequences of these findings remain unclear as yet, factors that may induce damage to the innermost retina should be elucidated.
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians-University, Mathildenstrasse 8, D-80336 Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gandorfer
authors.forename: C
authors.initials: C
authors.lastname: Haritoglou
authors.forename: C A
authors.initials: CA
authors.lastname: Gass
authors.forename: M W
authors.initials: MW
authors.lastname: Ulbig
authors.forename: A
authors.initials: A
authors.lastname: Kampik
mesh_terms: D001485:Basement Membrane / Q000601:surgery / Q000648:ultrastructure; D004396:Coloring Agents / Q000008:administration & dosage*; D019773:Epiretinal Membrane / Q000473:pathology / Q000601:surgery*; D005131:Eye Injuries / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D012160:Retina / Q000293:injuries* / Q000648:ultrastructure; D012167:Retinal Perforations / Q000601:surgery; D012421:Rupture; D013194:Staining and Labeling / Q000379:methods
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green