Aims: Internal limiting membrane (ILM) peeling with indocyanine green (ICG) staining is a commonly used procedure to treat idiopathic macular holes (MH). We report changes in the patterns of residual ICG fluorescence over time after vitrectomy using the Heidelberg Retina Angiograph 2 (HRA2).
Methods: Ten eyes (10 patients) that had undergone vitrectomy for MH with ILM peeling were included. Nine patients (90%) underwent ILM peeling with ICG, and one patient (10%) with triamcinolone acetonide (TA). We observed residual ICG using HRA2 postoperatively. Autofluorescence, optical coherence tomography images, and best-corrected visual acuity (BCVA) measurements also were obtained. The minimal follow-up was at least 3 months.
Results: The MHs closed postoperatively in all patients (100%). In eyes with ICG, the BCVA improved significantly (P<0.001) in eight eyes (89%) and was unchanged in one (11%). HRA2 showed the ICG fluorescence patterns but not TA postoperatively. The ICG hyperfluorescent signal was typically diffuse at the posterior retina and hypofluorescent around the fovea. The hyperfluorescence then migrated toward the optic nerve disc, presumably along the nerve fiber, and the area of ILM peeling was clearly identified. A large number of hyperfluorescent dots were observed instead of diffuse hyperfluorescence that was observed just after surgery.
Conclusions: Patterns of residual ICG fluorescence were sequentially observed with HRA2 after vitrectomy for MH with ICG-assisted ILM peeling.
- Heidelberg retina angiogram
- Indocyanine green
- Macular hole