Idiopathic macular hole surgery with low-concentration infracyanine green-assisted peeling of the internal limiting membrane.
OBJECTIVE
To evaluate the efficacy of pars plana vitrectomy with infracyanine green (IFCG)-assisted internal limiting membrane peeling for the treatment of idiopathic macular hole.


METHODS
Prospective, noncomparative interventional case series.


METHODS
Thirty-eight consecutive eyes of 35 patients with idiopathic macular hole were included in the study. Patients underwent early treatment diabetic retinopathy (ETDRS) visual acuity examination, dilated ophthalmoscopy, and optical coherence tomography before treatment and during follow-up. Fluorescein angiography was done in selected cases. Patients underwent a three-port pars plana vitrectomy with complete posterior hyaloid and epiretinal membrane removal. The internal limiting membrane (ILM) was stained with 0.5 cc of IFCG (0.5 mg/ml, 308 mOsm) and peeled up to the vascular arcades. Perfluoropropane gas (C(3)F(8)) 10% was used as tamponade.


RESULTS
Mean follow-up duration was 10 +/- 5 months (range, 3 to 24 months). Six eyes had stage 2 macular hole, 15 eyes stage 3, and 16 eyes stage 4. Overall, 37 of 38 macular holes closed after a single surgery. Median visual acuity was 20/100 (range, 20/400 to 20/50) before surgery and 20/50 (range, 20/640 to 20/25) after surgery. Visual acuity after surgery was 20/50 or better in 24 of 38 (63.1%) eyes. Twenty-five (65.8%) eyes improved by 2 or more lines, nine (23.7%) eyes were stable, and four (10.5%) eyes worsened by 2 or more lines.


CONCLUSIONS
This study suggests that IFCG (0.05%) effectively stains the ILM with apparent safety, and that IFCG-assisted peeling of the ILM may be useful in the treatment of idiopathic macular hole.
Lanzetta
Paolo
P
Department of Ophthalmology, University of Udine, Udine, Italy. paolo.lanzetta@uniud.it
Polito
Antonio
A
Del Borrello
Michele
M
Narayanan
Raja
R
Shah
Vinay A
VA
Frattolillo
Antonio
A
Bandello
Francesco
F
D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000473:pathology; D004396:Coloring Agents / Q000008:administration & dosage; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005451:Fluorescein Angiography; D005466:Fluorocarbons / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D011446:Prospective Studies; D012167:Retinal Perforations / Q000601:surgery*; D013194:Staining and Labeling / Q000379:methods; D041623:Tomography, Optical Coherence; D014792:Visual Acuity; D014821:Vitrectomy
D004396:Coloring Agents; D005466:Fluorocarbons; C116320:Infracyanine green; C042852:perflutren; D007208:Indocyanine Green