Indocyanine-green-assisted internal limiting membrane peeling in macular hole surgery--a follow-up study.
BACKGROUND
Macular hole surgery including vitrectomy and peeling of epiretinal membranes and the internal limiting membrane (ILM) has become a standard procedure in retinal surgery. Poor visualization of the ILM is an obstacle for successful surgery. Recently, indocyanine green (ICG) has been reported to be a helpful intraocular substance in identifying these membranes.


METHODS
Eighteen eyes with macular holes stages 2-4 were included. Intraoperatively, the ILM was stained with three drops of 1:9-diluted ICG. After 1 min incubation, the vitreous cavity was rinsed with Ringer's lactate solution, and the ILM was peeled. Autologous thrombocytes were applied to the macular hole and the eye was endotamponaded with 20% SF-6 gas. Preoperatively, 6 weeks postoperatively, and in 3-month intervals thereafter, visual acuity, fundus photographs, scanning laser ophthalmoscope imaging, and Humphrey 24-2 static perimetry was performed.


RESULTS
Intraoperatively, the ILM could be nicely visualized by ICG, which allowed easier and less traumatic peeling. At 6 weeks follow-up, visual acuity had improved in 14 of 18 patients, and the macular hole was closed 6 weeks after surgery. Scanning laser imaging revealed a strong signal. During prolonged follow-up, visual acuity declined due to cataract formation.


CONCLUSIONS
ICG as an intraocular tool for staining of the ILM is helpful in macular hole surgery. We observed no negative effects on retinal function, but patients should be followed.
Weinberger
Andreas W A
AW
Augenklinik des Universitätsklinikums Aachen, Pauwelsstr. 30, 52057 Aachen, Germany. aweinberger@ukaachen.de
Schlossmacher
Burkhard
B
Dahlke
Claudia
C
Hermel
Martin
M
Kirchhof
Bernd
B
Schrage
Norbert F
NF
D002386:Cataract / Q000209:etiology / Q000503:physiopathology; D004396:Coloring Agents; D019773:Epiretinal Membrane / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D007834:Lasers; D013508:Ophthalmologic Surgical Procedures; D009887:Ophthalmoscopy / Q000379:methods; D011183:Postoperative Complications; D012167:Retinal Perforations / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014792:Visual Acuity
D004396:Coloring Agents; D007208:Indocyanine Green