Histology of the vitreoretinal interface after staining of the internal limiting membrane using glucose 5% diluted indocyanine and infracyanine green

doi:10.1016/S0002-9394(03)00845-6

American Journal of Ophthalmology

Volume 137, Issue 2, February 2004, Pages 345-348

https://doi.org/10.1016/S0002-9394(03)00845-6 Get rights and content

Abstract

Purpose

To evaluate the effect of indocyanine green (ICG) diluted with glucose 5% on the human retina in an experimental setting in postmortem eyes and during surgery for macular hole formation.

Design

Histopathological evaluation.

Methods

Possible adverse effects of two different solutions of 0.05% ICG (Pulsion, Munich, Germany; and Infracyanine, Laboratoire SERB, Paris, France) diluted with glucose 5% were evaluated in four eyes of two donors. In one eye of each donor, the ICG-stained macula was illuminated with 380 to 760 nm using the light source of a commonly used vitrectomy machine. In the other eye, ICG was applied to the macula without illumination. The retinal specimens were evaluated using light- and electron microscopy. Additionally, the ultrastructure of the internal limiting membrane (ILM) of four eyes that underwent ICG-assisted vitrectomy for macular hole formation was examined.

Results

In the postmortem study, both solutions of ICG caused significant morphologic alterations of the inner retina after light exposure. There was disorganization of the inner retina and complete loss of ILM after application of the dye and illumination. In contrast, no abnormalities were found after application of the dye without illumination and in unstained control specimens. No differences were noted between the two ICG products. Specimens of the ILM harvested during vitrectomy revealed cellular elements adjacent to the retinal side of the ILM.

Conclusions

Staining of the ILM using ICG diluted in glucose 5% followed by illumination might induce an adverse effect on the inner retina and may result in an alteration of the cleavage plane from the ILM to the innermost retinal layers.

References (5)

K. Kadonosono et al.
Staining of the internal limiting membrane in macular hole surgery
Arch Ophthalmol
(2000)
H. Enaida et al.
Morphological and functional damage of the retina caused by intravitreous indocyanine green in rat eyes
Graefes Arch Clin Exp Ophthalmol
(2002)

There are more references available in the full text version of this article.

Cited by (66)

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However, IfCG has a clear advantage over ICG because it is synthesized without sodium iodine, as it is believed that iodine damages the cornea and retina.29–31 On the other hand, iodide-free IfCG is not water soluble and has to be dissolved in a 5% glucose solvent IfCG.32–34 It is commercially available under the brand name of Infracyanine (Laboratoires SERB, Paris, France; 25-mg vial).
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To investigate the in vitro effect of pH, osmolarity, solvent, and light interaction on currently used and novel dyes to minimize dye-related retinal toxicity.
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Retinal pigment epithelium (RPE) human cells (ARPE-19) were exposed for 10 minutes to different pH solutions (4, 5, 6, 7, 7.5, 8, and 9) and glucose solutions (2.5%, 5.0%, 10%, 20%, 40%, and 50%) with osmolarity from 142 to 2530 mOsm, with and without 0.5 mg/mL trypan blue. R28 cells were also incubated with glucose (150, 310, and 1000 mOsm) and mannitol used as an osmotic control agent in both experiments. Dye-light interaction was assessed by incubating ARPE-19 for 10 minutes with trypan blue, brilliant blue, bromophenol blue, fast green, light green, or indigo carmine (0.05 mg/mL diluted in balanced saline solution) in the presence of high-brightness xenon and mercury vapor light sources.
Solutions with nonphysiologic pH, below 7 and above 7.5, proved to be remarkably toxic to RPE cells with or without trypan blue. Also, all glucose solutions were deleterious to RPE (P < .001) even in iso-osmolar range. No harmful effect was found with mannitol solutions. Among the dyes tested, only light green and fast green were toxic to ARPE-19 (P < .001). Light exposure did not increase RPE toxicity either with xenon light or mercury vapor lamp.
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Brief reportHistology of the vitreoretinal interface after staining of the internal limiting membrane using glucose 5% diluted indocyanine and infracyanine green

Abstract

Purpose

Design

Methods

Results

Conclusions

Staining of the internal limiting membrane in macular hole surgery

Arch Ophthalmol

Morphological and functional damage of the retina caused by intravitreous indocyanine green in rat eyes

Graefes Arch Clin Exp Ophthalmol

Brief report
Histology of the vitreoretinal interface after staining of the internal limiting membrane using glucose 5% diluted indocyanine and infracyanine green