Functional outcome of indocyanine green-assisted macular surgery: 7-year follow-up.
OBJECTIVE
To evaluate the long-term functional results after surgery for macular pucker and macular holes with indocyanine green (ICG) staining of the internal limiting membrane.


METHODS
Long-term functional and anatomical outcomes of 16 eyes of 16 patients were evaluated for 7.3 years after ICG-assisted macular surgery. Examinations performed included best-corrected visual acuity, Goldmann perimetry, Arden color contrast test, optical coherence tomography, and fundus photography. Ten eyes had undergone surgery for macular holes, and 6 eyes had been treated for macular pucker. Indocyanine green with a concentration of 0.05% and an osmolarity of 275 mOsm had been used to stain the internal limiting membrane.


RESULTS
Mean follow-up time was 7.3 years. Eighty-eight percent (14) of the eyes had undergone cataract surgery either in a combined intervention primarily (n = 3) or in the years after the ICG-assisted macular surgery (n = 11). One patient was still phakic with a pronounced cataract at last follow-up. Over all patients, best-corrected visual acuity did not increase significantly from 20/200 (median) before macular surgery to the present 20/70 (median). Large visual field defects (VFDs) were found in 10 of 16 patients after internal limiting membrane staining using ICG. In 8 of these 10 eyes, the VFDs had been diagnosed immediately after vitrectomy and remained unchanged throughout the period of review. In 2 eyes, a VFD was noted at the last follow-up visit despite an unremarkable Goldmann perimetry performed at follow-up visits after 3 months and 6 months. Pathologic color testing was found in 15 of 16 patients when comparing the operated and the fellow eye. A nonglaucomatous optic nerve atrophy was found in 11 of 16 eyes. The optical coherence tomography revealed macular hole closure in all 10 patients.


CONCLUSIONS
Indocyanine green-assisted macular surgery might lead to optic nerve atrophy in the long-term and persistent VFDs. In addition, new VFDs may occur in the postoperative course. An affection of color vision also underlines the potential impact of ICG on visual function. A long-term observation of patients after ICG-assisted vitrectomy seems mandatory to reliably detect functional adverse events.
von Jagow
Burkhard
B
Department of Ophthalmology, Ludwig-Maximilian-University, Munich, Germany.
Höing
Anna
A
Gandorfer
Arnd
A
Rudolph
Günther
G
Kohnen
Thomas
T
Kampik
Anselm
A
Haritoglou
Christos
C
D000368:Aged; D000369:Aged, 80 and over; D001485:Basement Membrane / Q000473:pathology; D003118:Color Perception / Q000502:physiology*; D004396:Coloring Agents; D019773:Epiretinal Membrane / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D012167:Retinal Perforations / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013194:Staining and Labeling; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology*; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology*; D014821:Vitrectomy
D004396:Coloring Agents; D007208:Indocyanine Green