Ocular toxicity of intravitreal indocyanine green.
We report 6 cases of indocyanine green (ICG)-related ocular toxicity after intravitreal ICG usage. Five cases had preoperative diagnosis of macular hole, 1 case had preoperative rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy. All cases received vitrectomy, ICG-assisted internal limiting membrane (ILM) peeling and air-fluid exchange. All eyes had residual ICG left at the end of surgery. Patients were followed up with indirect ophthalmoscopy, visual acuity, color fundus photography, fluorescein angiography, and ocular coherence tomography. Circular foveal retinal pigment epithelium atrophy larger than the area of macular hole and surrounding cuff was noted in 4 of 5 cases with preoperative macular hole. The other eye with preoperative diagnosis of macular hole had shallow anterior chamber and low intraocular pressure lasting for 1 week postoperatively. Diffuse retinal pigment epithelial atrophy was noted in the eye with preoperative proliferative vitreoretinopathy. Four eyes demonstrated optic atrophy postoperatively. Ocular toxicity caused by ICG may present as pigment epithelial atrophy, which is characteristically larger than the previous area of macular hole and surrounding cuff. Disc atrophy, retinal toxicity, and ocular hypotony were also observed in some cases. To prevent toxicity, residual ICG and ICG-stained ILM must be removed as completely as possible.
Cheng
San-Ni
SN
Department of Ophthalmology, Changhua Christian Hospital, Republic of China.
Yang
Te-Cheng
TC
Ho
Jau-Der
JD
Hwang
Jiunn Feng
JF
Cheng
Cheng-Kuo
CK
D000368:Aged; D001485:Basement Membrane / Q000473:pathology / Q000601:surgery; D002924:Ciliary Body / Q000187:drug effects / Q000473:pathology; D004396:Coloring Agents / Q000009:adverse effects*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D010857:Pigment Epithelium of Eye / Q000187:drug effects / Q000473:pathology; D012160:Retina / Q000187:drug effects* / Q000473:pathology; D012163:Retinal Detachment / Q000601:surgery; D012164:Retinal Diseases / Q000139:chemically induced* / Q000175:diagnosis; D012167:Retinal Perforations / Q000601:surgery; D012189:Retrospective Studies; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D018630:Vitreoretinopathy, Proliferative / Q000601:surgery
D004396:Coloring Agents; D007208:Indocyanine Green