title: Comparative evaluation of no dye assistance, indocyanine green and triamcinolone acetonide for internal limiting membrane peeling during macular hole surgery.
abstract: OBJECTIVE
  To evaluate the anatomical closure rate and visual outcome in patients undergoing pars plana vitrectomy with internal limiting membrane peeling without dye enhancement and with indocyanine green or triamcinolone acetonide assistance.
  
  
  METHODS
  This is a retrospective, comparative interventional case series. The electronic charts of 435 eyes of 415 patients with idiopathic macular holes who underwent macula hole surgery were reviewed from January 2003 to April 2010. The patients were assigned to 3 groups: no dye assistance (Group 1), indocyanine green-assisted (Group 2), and triamcinolone acetonide-assisted internal limiting membrane peel (Group 3). The data were recorded for 3-, 6-, and 12-month follow-up visits. Main outcome measures were postoperative visual acuity and macular hole closure.
  
  
  RESULTS
  The overall macular hole closure rate with a single surgery was 94.7% (108 of 114). In Group 1: 91.4% (191 of 209), in Group 2: 94.1% (112 of 119), and in Group 3: 95.9% (93 of 97) achieved closure. Closure rate for holes that were ≤400 μm in diameter was 98.8% compared with >400 μm, which was 90.4% (P = 0.001). There was a statistically significant (P < 0.001) improvement from preoperative visual acuity to postoperative visual acuity in all groups across all time points. There was no statistically significant visual acuity difference among three groups. At 12-month follow-up, 77.7% in Group 1, 66.1% in Group 2, and 81.3% in Group 3 achieved 20/50 visual acuity or better.
  
  
  CONCLUSIONS
  The study shows that good anatomical and functional results can be achieved with no dye and with indocyanine green or triamcinolone acetonide dye assistance for internal limiting membrane peeling during macular hole surgery. Overall, visual acuity levels did not differ among groups, although subanalysis of the results suggests subtle indocyanine green toxicity.
authors.affiliation: Associated Retina Consultants, Phoenix, Arizona, USA. mtsipursky@yahoo.com
authors.forename: Michael S
authors.initials: MS
authors.lastname: Tsipursky
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Heller
authors.forename: Stephen A
authors.initials: SA
authors.lastname: De Souza
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Gordon
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Bryan
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Ziemianski
authors.forename: Clive H
authors.initials: CH
authors.lastname: Sell
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D004396:Coloring Agents / Q000008:administration & dosage* / Q000009:adverse effects; D019773:Epiretinal Membrane / Q000601:surgery*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012167:Retinal Perforations / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D014222:Triamcinolone Acetonide / Q000627:therapeutic use*; D014792:Visual Acuity; D014821:Vitrectomy / Q000379:methods*
chemical_list: D004396:Coloring Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide; D007208:Indocyanine Green