title: Indocyanine green-assisted internal limiting membrane peeling in macular hole surgery: a meta-analysis.
abstract: BACKGROUND
  The opinion of application of indocyanine green (ICG) in the macular hole surgery was contradictory. Here we conducted a meta-analysis to evaluate the effect of in internal limiting membrane (ILM) peeling for macular hole surgery.
  
  
  RESULTS
  We searched electronic databases for comparative studies published before July 2012 of ILM peeling with and without ICG. Twenty-two studies including 1585 eyes were included. Visual acuity (VA) improvement, including the postoperative rate of ≥20/40 VA gained (OR, 0.65; 95% CI, 0.43 to 0.97; P = 0.033) and increased LogMAR (WMD, -0.09; 95% CI, -0.16 to -0.02; P = 0.011), was less in the ICG group. The risk of visual field defects was greater in the ICG group than in the non-ICG group. There was no significant difference in the rate of anatomical outcomes between ILM peeling procedures performed with and without ICG. RPE changes and other postoperative complications were not significantly different between the ICG and non-ICG groups. An additional analysis showed that the VA improvement of the ICG group was less than the non-ICG group only within the first year of follow up. A subgroup analysis showed that the rate of VA improvement was lower in the ICG group than in other adjuncts group. A higher rate of secondary closure and less VA improvement were observed in a high proportion (>0.1%) of the ICG group. A sensitivity analysis after the randomized-controlled trials were excluded from the meta-analysis demonstrated no differences compared with the overall results.
  
  
  CONCLUSIONS
  This meta-analysis demonstrated that there is no evidence of clinical superiority in outcomes for ICG-assisted ILM peeling procedure over the non-ICG one. The toxicity of ICG should be considered when choosing the various staining methods.
authors.affiliation: Department of Ophthalmology, Affiliated Tenth People's Hospital of Tongji University, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wu
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.forename: Ding
authors.initials: D
authors.lastname: Xu
authors.forename: Yan-Hong
authors.initials: YH
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Ba
authors.forename: Xiao-Long
authors.initials: XL
authors.lastname: Zhang
authors.forename: Fang
authors.initials: F
authors.lastname: Wang
authors.forename: Jing
authors.initials: J
authors.lastname: Yu
mesh_terms: D002986:Clinical Trials as Topic; D005500:Follow-Up Studies; D006801:Humans; D007208:Indocyanine Green / Q000378:metabolism*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D017594:Publication Bias; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D055213:Retinal Pigment Epithelium / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D007208:Indocyanine Green