title: Indocyanine-green-assisted internal limiting membrane peeling in macular hole surgery--a follow-up study.
abstract: 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.
authors.affiliation: Augenklinik des Universitätsklinikums Aachen, Pauwelsstr. 30, 52057 Aachen, Germany. aweinberger@ukaachen.de
authors.forename: Andreas W A
authors.initials: AW
authors.lastname: Weinberger
authors.forename: Burkhard
authors.initials: B
authors.lastname: Schlossmacher
authors.forename: Claudia
authors.initials: C
authors.lastname: Dahlke
authors.forename: Martin
authors.initials: M
authors.lastname: Hermel
authors.forename: Bernd
authors.initials: B
authors.lastname: Kirchhof
authors.forename: Norbert F
authors.initials: NF
authors.lastname: Schrage
mesh_terms: 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
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green