title: Indocyanine green assisted retinal internal limiting membrane removal in stage 3 or 4 macular hole surgery.
abstract: OBJECTIVE
  To determine surgical outcome in primary idiopathic stage 3 or 4 macular holes with indocyanine green (ICG) assisted retinal internal limiting membrane (ILM) peeling.
  
  
  METHODS
  A prospective, consecutive, interventional case series with 41 eyes of 40 patients was included. No patient defaulted follow up. Besides a standard macular hole surgery, all eyes received ICG assisted ILM removal of 3-4 disc diameters around macular holes. At the end of the surgery, 12% perfluoropropane gas was used. A face down posture for 2 weeks was required postoperatively.
  
  
  RESULTS
  The mean follow up period was 15.1 months (range 6-24 months). Twenty (48.8%) eyes had stage 3 macular holes and 21 (51.2%) had stage 4 macular holes. The overall median duration of holes was 11 months. 19 (46.3%) were chronic macular holes of more than 12 months' duration. The anatomical success rates after one surgery was 87.8% (36 eyes), while that of chronic and non-chronic ones was 78.9% and 95.5%, respectively. The median preoperative and postoperative visual acuity was 20/200 (range 20/60 to counting fingers) and 20/100 (range 20/20 to 20/400), respectively. 24 (58.5%) eyes had improvement of two or more Snellen lines. The mean was 3.2 lines (range two to nine lines), with 3.6 lines and 2.7 lines for non-chronic and chronic holes, respectively. For all the 41 eyes, 16 (39%) eyes had a final visual acuity of 20/50 or better.
  
  
  CONCLUSIONS
  ICG assisted retinal ILM removal, in idiopathic primary chronic and non-chronic stage 3 or 4 macular hole surgery, appears to give a promising anatomical closure rate without compromising the visual result.
authors.affiliation: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital Prince of Wales Hospital, Hong Kong, People's Republic of China. kwokak@netvigator.com
authors.forename: A K H
authors.initials: AK
authors.lastname: Kwok
authors.forename: T Y Y
authors.initials: TY
authors.lastname: Lai
authors.forename: W
authors.initials: W
authors.lastname: Man-Chan
authors.forename: D C F
authors.initials: DC
authors.lastname: Woo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002387:Cataract Extraction / Q000379:methods; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation / Q000379:methods; D012160:Retina / Q000601:surgery*; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green