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Br J Ophthalmol 2003;87:71-74 doi:10.1136/bjo.87.1.71
  • Original Article
    • Clinical science

Indocyanine green assisted retinal internal limiting membrane removal in stage 3 or 4 macular hole surgery

  1. A K H Kwok1,3,
  2. T Y Y Lai1,
  3. W Man-Chan2,
  4. D C F Woo4
  1. 1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital
  2. 2Prince of Wales Hospital, Hong Kong, People’s Republic of China
  3. 3Department of Ophthalmology, Queen Mary Hospital, Hong Kong, People’s Republic of China
  4. 4Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, People’s Republic of China
  1. Correspondence to: Dr Alvin K H Kwok, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong; kwokak{at}netvigator.com
  • Accepted 16 August 2002

Abstract

Aims: To determine surgical outcome in primary idiopathic stage 3 or 4 macular holes with indocyanine green (ICG) assisted retinal internal limiting membrane (ILM) peeling.

Methods: A prospective, consecutive, interventional case series with 41 eyes of 40 patients was included. No patient defaulted follow up. Besides a standard macular hole surgery, all eyes received ICG assisted ILM removal of 3–4 disc diameters around macular holes. At the end of the surgery, 12% perfluoropropane gas was used. A face down posture for 2 weeks was required postoperatively.

Results: The mean follow up period was 15.1 months (range 6–24 months). Twenty (48.8%) eyes had stage 3 macular holes and 21 (51.2%) had stage 4 macular holes. The overall median duration of holes was 11 months. 19 (46.3%) were chronic macular holes of more than 12 months’ duration. The anatomical success rates after one surgery was 87.8% (36 eyes), while that of chronic and non-chronic ones was 78.9% and 95.5%, respectively. The median preoperative and postoperative visual acuity was 20/200 (range 20/60 to counting fingers) and 20/100 (range 20/20 to 20/400), respectively. 24 (58.5%) eyes had improvement of two or more Snellen lines. The mean was 3.2 lines (range two to nine lines), with 3.6 lines and 2.7 lines for non-chronic and chronic holes, respectively. For all the 41 eyes, 16 (39%) eyes had a final visual acuity of 20/50 or better.

Conclusion: ICG assisted retinal ILM removal, in idiopathic primary chronic and non-chronic stage 3 or 4 macular hole surgery, appears to give a promising anatomical closure rate without compromising the visual result.

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