title: Indocyanine green-assisted internal limiting membrane peeling for macular holes: toxicity?
abstract: BACKGROUND
  Indocyanine green (ICG) staining facilitates definitive internal limiting membrane (ILM) peeling during macular hole surgery (MHS), but might cause toxicity.
  
  
  OBJECTIVE
  To determine if ICG to assist in ILM peeling has an effect on anatomic or visual results in MHS with ILM peeling.
  
  
  METHODS
  Retrospective, comparative review including primary analysis of 173 cases undergoing MHS. Visual acuity >or=20/50, <or=20/200, three-line visual acuity improvement, and anatomic success rates were analyzed as endpoints.
  
  
  RESULTS
  The single operation hole closure rate was 87% with ICG versus 83% without ICG (P = 0.52). Postoperative median best-corrected visual acuity was 20/70 and 20/80 in the ICG and no ICG groups with median follow-up intervals of 8 and 9 months. The use of ICG was associated with a higher rate of <or=20/200, but ILM peeling and ICG use was not associated with better anatomic success, visual improvement, or >or=20/50 visual acuity.
  
  
  CONCLUSIONS
  ICG usage during macular hole surgery was not associated with worse visual outcomes, suggesting possible toxic effects reported are not clinically significant. If the ILM cannot be peeled effectively, ICG should be considered a safe option.
authors.affiliation: Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida, USA.
authors.forename: Elias
authors.initials: E
authors.lastname: Mavrofrides
authors.forename: William E
authors.initials: WE
authors.lastname: Smiddy
authors.forename: John W
authors.initials: JW
authors.lastname: Kitchens
authors.forename: Alberto
authors.initials: A
authors.lastname: Salicone
authors.forename: William
authors.initials: W
authors.lastname: Feuer
mesh_terms: D000368:Aged; D001485:Basement Membrane / Q000473:pathology / Q000601:surgery; D004396:Coloring Agents / Q000009:adverse effects; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007208:Indocyanine Green / Q000009:adverse effects; D007267:Injections; D008297:Male; D015999:Multivariate Analysis; D012160:Retina / Q000187:drug effects / Q000503:physiopathology; D012167:Retinal Perforations / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013194:Staining and Labeling / Q000379:methods; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology; D014821:Vitrectomy; D014822:Vitreous Body / Q000187:drug effects
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green