title: Macular edema and visual loss after macular pucker surgery with ICG-assisted internal limiting membrane peeling.
abstract: OBJECTIVE
  To describe the occurrence of massive macular edema and visual loss after indocyanine green-assisted (ICG) macular pucker surgery.
  
  
  RESULTS
  A 74 years old female presented with a macular pucker and a hypertrophy of the retinal pigment epithelium (RPE) in her left eye. The preoperative visual acuity (VA) was 20/100. Surgery consisted of cataract extraction, lens implantation and standard pars plana vitrectomy with peeling of epiretinal tissue followed by the removal of the internal limiting membrane (ILM) remnants stained using a 0.05% ICG solution. One day after surgery, VA was counting fingers. There was an extensive macular edema and retinal thickening with hyperfluorescence during fluorescein angiography and pronounced autofluorescence using ICG filters. During follow up, the macular edema resolved completely, but VA decreased to 20/800 at six months postoperatively. There was a central scotoma and unstable fixation seen during microperimetry.
  
  
  CONCLUSIONS
  This case report indicates that ICG might come into contact with bare retina if injected following removal of epiretinal membranes. Whether the observed RPE hypertrophy might have contributed to the pathogenesis of the adverse effect described remains hypothetical.
authors.affiliation: Clinica Oculistica Università di Trieste, Ospedale Maggiore--Italy. tognetto@univ.trieste.it
authors.forename: D
authors.initials: D
authors.lastname: Tognetto
authors.forename: C
authors.initials: C
authors.lastname: Haritoglou
authors.forename: A
authors.initials: A
authors.lastname: Kampik
authors.forename: G
authors.initials: G
authors.lastname: Ravalico
mesh_terms: D000368:Aged; D001485:Basement Membrane / Q000601:surgery; D001766:Blindness / Q000209:etiology*; D002387:Cataract Extraction; D004396:Coloring Agents; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D005451:Fluorescein Angiography; D006801:Humans; D007208:Indocyanine Green; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000209:etiology*; D011183:Postoperative Complications; D013194:Staining and Labeling / Q000379:methods; D014792:Visual Acuity; D014821:Vitrectomy
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green