title: Indocyanine green for successful repair of a long-standing macular hole.
abstract: OBJECTIVE
  To report on the successful closure of a persistent chronic macular hole using indocyanine green (ICG) during the second surgical approach.
  
  
  METHODS
  Interventional case report.
  
  
  METHODS
  A patient with a long standing macular hole (18 years) underwent pars plana vitrectomy with peeling of the internal limiting membrane (ILM). While no dye was used during the first operation, ICG (0.05%, Pulsion) was applied during the second procedure. The light source was turned off immediately after the ICG application until the dye was washed out after a period of 15 seconds. Tissue harvested during the second surgical approach was prepared for electron microscopy.
  
  
  RESULTS
  After the failure of the first operation, areas of incomplete ILM peeling could be stained using ICG and a thorough ILM removal was achieved. Postoperatively, the macular hole was closed, as confirmed by optical coherence tomography. Visual acuity increased from 20/200 to 20/50. No visual field defects were seen postoperatively. There were only few cellular elements adherent to the retinal surface of the ILM as seen during electron microscopy.
  
  
  CONCLUSIONS
  In cases where tractional forces due to incomplete ILM removal are considered responsible for the persistence of a macular hole, ICG is useful to identify areas of unpeeled ILM. Under certain safety precautions no adverse effect on functional outcome was seen.
authors.affiliation: Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany. christos.haritoglou@ak-i.med.uni-muenchen.de
authors.forename: Christos
authors.initials: C
authors.lastname: Haritoglou
authors.forename: Aljoscha S
authors.initials: AS
authors.lastname: Neubauer
authors.forename: Arnd
authors.initials: A
authors.lastname: Gandorfer
authors.forename: Martin
authors.initials: M
authors.lastname: Thiel
authors.forename: Anselm
authors.initials: A
authors.lastname: Kampik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007368:Interferometry; D008027:Light; D012086:Reoperation; D012167:Retinal Perforations / Q000175:diagnosis / Q000601:surgery*; D014054:Tomography / Q000379:methods; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green