Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation

doi:10.1016/S0002-9394(02)01816-0

American Journal of Ophthalmology

Volume 134, Issue 6, December 2002, Pages 836-841

This study was presented in part at the 105th Annual Meeting of the American Academy of Ophthalmology, New Orleans, LA, November 11–14, 2001.

https://doi.org/10.1016/S0002-9394(02)01816-0 Get rights and content

Abstract

Purpose

To report the ultrastructure of the internal limiting membrane (ILM) after macular hole surgery with indocyanine green (ICG) staining and to investigate an association with the postoperative functional outcome.

Design

Retrospective, noncomparative analysis of a consecutive case series.

Methods

Twenty eyes of 20 patients after macular hole surgery with ICG staining were included. Visual acuity and Goldmann perimetry were obtained before and after surgery. The ILM was obtained during three-port pars plana vitrectomy for idiopathic macular hole. Twenty-five milligrams of sterile ICG powder was dissolved in 5 ml of sterile water as recommended by the manufacturer and then diluted in balanced salt solution. The ultrastructure of the ILM was analyzed using light and transmission electron microscopy. Osmolarity and pH of the ICG solution were measured preoperatively.

Results

There was no statistically significant improvement of postoperative visual acuity after ICG-assisted peeling (P = .755). In seven patients, postoperative visual field defects occurred. Indocyanine green-stained specimens revealed cellular elements resembling the plasma membrane of Müller cells and other undetermined retinal structures adherent to the retinal side of the ILM. Histologic findings disclosed no difference between patients with and without visual field defects after the use of ICG. The osmolarity of the ICG solution applied was 275 mOsm; pH was 7.5.

Conclusions

Intravitreal application of ICG may cause retinal damage by altering the cleavage plane to the innermost retinal layers. That may result in less improvement of visual acuity and unexpected visual field defects. The underlying mechanisms of action remain unclear and are the subject of ongoing investigations.

Section snippets

Methods

This study is a retrospective, noncomparative analysis of 20 consecutive eyes of 20 consecutive patients with an idiopathic macular hole. Patients with a traumatic macular hole or any other retinal disease influencing visual acuity such as diabetic retinopathy or age-related macular degeneration were excluded. Patients were examined 1 day preoperatively and at least 2 months after surgery. Examination included best-corrected visual acuity, which was tested using standardized acuity charts in

Results

The 20 patients, six male and 14 female, had a mean age of 65.4 years. The macular hole was graded as stage 2 in two, stage 3 in 17 and stage 4 in one patient. Median best-corrected preoperative visual acuity was 20/125 (range, 20/400 to 20/50). In 18 of 20 patients the macular hole could be closed by a single surgical procedure. One of two patients with persisting macular holes underwent a successful second reoperation (with ICG) and experienced an increase in visual acuity postoperatively; in

Discussion

Removal of the ILM in macular hole surgery without the use of ICG has been shown to be a safe procedure, leading to good functional outcome.2, 3 In a prospective consecutive series of 105 patients (mean age, 67.5 years) with an idiopathic macular hole, median best-corrected visual acuity improved from 20/100 preoperatively to 20/40 postoperatively, and there was a median gain of 5 lines. Visual acuity improved in 95% of patients. The incidence of peripheral visual field defects was less than 1%.

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Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation

Abstract

Purpose

Design

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Am J Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Vitreous surgery for macular holes. Results of a pilot study

Arch Ophthalmol