Abstract
Purpose
Indocyanine green (ICG) staining of the internal limiting membrane has facilitated ILM peeling in macular hole surgery. However, it has been reported that ICG-assisted peeling of the ILM may result in retinal damage and unfavorable functional outcome. Therefore, we analyzed our visual and anatomical results of ICG assisted macular hole surgery.
Methods
In a retrospective study the records of a consecutive series of 37 patients with full-thickness idiopathic macular holes operated with ICG-assisted ILM peeling by a single surgeon were analyzed. All patients underwent a standard three-port vitrectomy with surgically induced posterior vitreous detachment, staining of the ILM with ICG, peeling of the ILM in a circular manner around the fovea, and SF6 20% endotamponade.
Results
A total of 37 patients (37 eyes) were included in the study. The mean age was 69±7 years (range 52–81 years), and there were 26 women and 11 men. The follow-up ranged from 6 to 30 months (mean 18±6 months). At baseline visual acuity ranged from 20/400 to 20/40. Anatomically, 13 eyes had stage 2 holes, 21 eyes (57%) stage 3 holes, and three eyes stage 4 holes. At the postoperative visit (8–12 weeks after surgery) anatomical closure of the macular hole was achieved in 36 eyes. Visual acuity ranged between 20/400 and 20/20. At the last follow-up after initial surgery the macular hole was closed in all eyes. Visual acuity ranged from 20/200 to 20/20.
Conclusion
In our retrospective series anatomical and functional results of macular hole surgery with ICG-assisted peeling of the ILM are satisfactory. Primary hole closure was achieved in 97% of eyes and visual acuity increased in 62% of eyes in our series.
References
Banker AS, Freeman WR, Jung WK, Munguia D, Azen SP, Group TVFMHS (1997) Vision-threatening complications of surgery for full-thickness macular holes. Ophthalmology 104(9):1442–1453
Burk SE, Da Mata AP, Snyder ME, Rosa RH, Foster RE (2000) Indocyanine green-assisted peeling of the retinal internal limiting membrane. Ophthalmology 107(11):2010–2014
Clarkson JG, Green WR, Massof D (1977) A histopathologic review of 168 cases of preretinal membrane. Am J Ophthalmol 84(1):1–17
Da Mata AP, Burk SE, Riemann CD, Rosa RH Jr, Snyder ME, Petersen MR, Foster RE (2001) Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair. Ophthalmology 108:1187–1192
Eckardt C, Eckardt U, Groos S, Luciano L, Reale E (1997) [Removal of the internal limiting membrane in macular holes. Clinical and morphological findings]. Ophthalmologe 94(8):545–551
Ezra E, Aylward WG, Gregor ZJ (1997) Membranectomy and autologous serum for the retreatment of full-thickness macular holes. Arch Ophthalmol 115(10):1276–1280
Faude F, Edel E, Dannhauer M, Petzel C, Meier P, Wiedemann P (1997) Autologe Thrombozytenapplikation bei der Behandlung des idiopatischen Makulaforamens. Ophthalmologe 94:877–881
Fine BS (1961) Limiting membranes of sensory retina and pigment epithelium. An electron microscopic study. Arch Ophthalmol 66:847–860
Freeman WR, Azen SP, Kim JW, El-Haig W, Mishell DR, Bailey I (1997) Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Arch Ophthalmol 115:11–21
Gass JDM (1988) Idiopathic senile macular hole: its early stages and pathogenesis. Arch Ophthalmol 110:629–639
Gass JDM (1995) Reappraisal of biomicroscopic classification of stages of development of a macular hole. Am J Ophthalmol 119:752–759
Gaudric A, Paques M, Massin P, Santiago PY, Dosquet C (1997) Use of autologous platelet concentrate in macular hole surgery: report of 77 cases. Dev Ophthalmol 29:30–35
Gaudric A, Haouchine B, Massin P, Paques M, Blain P, Erginay A (1999) Macular hole formation: new data provided by optical coherence tomography. Arch Ophthalmol 117(6):744–751
Guyer DR, Green WR, de Bustros S, Fine SL (1990) Histopathologic features of idiopathic macular holes and cysts. Ophthalmology 97:1045–1051
Haritoglou C, Gandorfer A, Gass CA, Kampik A (2002) Indocyanine green staining and removal of internal limiting membrane in macular hole surgery: histology and outcome. Am J Ophthalmol 133(4):587–588; author reply 588
Haritoglou C, Gass CA, Schaumberger M, Ehrt O, Gandorfer A, Kampik A (2001) Macular changes after peeling of the internal limiting membrane in macular hole surgery. Am J Ophthalmol 132:363–368
Haritoglou C, Gandorfer A, Gass CA, Schaumberger M, Ulbig MW, Kampik A (2002) Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation. Am J Ophthalmol 134(6):836–841
Horiguchi M, Miyake K, Ohta I, Ito Y (1998) Staining of the lens capsule for circular continuous capsulorrhexis in eyes with white cataract. Arch Ophthalmol 116(4):535–537
Hutton WL, Fuller DG, Snyder WB, Fellman RL, Swanson WH (1996) Visual field defects after macular hole surgery. Ophthalmology 103(12):2152–2159
Johnson RN, Gass JD (1988) Idiopathic macular holes. Observations, stages of formation, and implications for surgical intervention. Ophthalmology 95(7):917–924
Kim JW, Freeman WR, el-Haig W, Maguire AM, Arevalo JF, Azen SP (1995) Baseline characteristics, natural history, and risk factors to progression in eyes with stage 2 macular holes. Results from a prospective randomized clinical trial. Vitrectomy for Macular Hole Study Group. Ophthalmology 102(12):1818–1828; discussion 1828–1829
Kim JW, Freeman WR, Azen SP, el-Haig W, Klein DJ, Bailey IL (1996) Prospective randomized trial of vitrectomy or observation for stage 2 macular holes. Vitrectomy for Macular Hole Study Group. Am J Ophthalmol 121(6):605–614
Leonard RE 2nd, Smiddy WE, Flynn HW Jr, Feuer W (1997) Long-term visual outcomes in patients with successful macular hole surgery. Ophthalmology 104(10):1648–1652
Livingstone BI, Bourke RD (1999) Retrospective study of macular holes treated with pars plana vitrectomy. Aust N Z J Ophthalmol 27(5):331–341
Maguire AM, Smiddy WE, Nanda SK, Michels RG, de la Cruz Z, Green WR (1990) Clinicopathologic correlation of recurrent epiretinal membranes after previous surgical removal. Retina 10(3):213–222
Michels RG (1982) A clinical and histopathologic study of epiretinal membranes affecting the macula and removed by vitreous surgery. Trans Am Ophthalmol Soc 80:580–656
Olsen TW, Sternberg P, Capone A, Martin DF, Lim JI, Grossniklaus HE, Aaberg TM (1998) Macular hole surgery using thrombin-activated fibrinogen and selective removal of the internal limiting membrane. Retina 18:322–329
Paques M, Chastang C, Mathis A, Sahel J, Massin P, Dosquet C, Korobelnik J-F, Le Gargasson J-F, Gaudric A (1999) Effect of autologous platelet concentrate in surgery for idiopathic macular hole. Ophthalmology 106(5):932–938
Park DW, Sipperley JO, Sneed SR, Dugel PU, Jacobsen J (1999) Macular hole surgery with international-limiting membrane peeling and intravitreous air. Ophthalmology 106(7):1392–1398
Scott IU, Smiddy WE, Merikansky A, Feuer W (1997) Vitreoretinal surgery outcomes. Impact on bilateral visual function. Ophthalmology 104(6):1041–1048
Smiddy WE, Michels RG, Glaser BM, de Bustros S (1988) Vitrectomy for impending idiopathic macular holes. Am J Ophthalmol 105(4):371–376
Smiddy WE, Michels RG, de Bustros S, de la Cruz Z, Green WR (1989) Histopathology of tissue removed during vitrectomy for impending idiopathic macular holes. Am J Ophthalmol 108(4):360–364
Smiddy WE, Michels RG, Green WR (1990) Morphology, pathology, and surgery of idiopathic vitreoretinal macular disorders. A review. Retina 10(4):288–296
Weinberger AWA, Schlossmacher B, Dahlke C, Hermel M, Kirchhof B, Schrage NF (2002) Indocyanine-green-assisted internal limiting membrane peeling in macular hole surgery—a follow-up study. Graefe's Arch Clin Exp Ophthalmol 240(11):913–917
Yooh HS, Brooks HL, Capone A, L'Hernault NL, Grossniklaus HE (1996) Ultrastructural features of tissue removed during idiopathic macular hole surgery. Am J Ophthalmol 122(1):67–75
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Presented in part at the annual meeting of the Deutsche Ophthalmologische Gesellschaft (DOG), Berlin, 2002
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Wolf, S., Reichel, M.B., Wiedemann, P. et al. Clinical findings in macular hole surgery with indocyanine green-assisted peeling of the internal limiting membrane. Graefe's Arch Clin Exp Ophthalmol 241, 589–592 (2003). https://doi.org/10.1007/s00417-003-0673-1
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DOI: https://doi.org/10.1007/s00417-003-0673-1