Indocyanine green facilitates removal of epiretinal and internal limiting membranes in myopic eyes with retinal detachment

doi:10.1016/S0002-9394(00)00848-5

American Journal of Ophthalmology

Volume 131, Issue 3, March 2001, Pages 388-390

https://doi.org/10.1016/S0002-9394(00)00848-5 Get rights and content

Abstract

PURPOSE: To describe the use of intravitreal indocyanine green as an aid to identifying epiretinal membranes and internal-limiting membranes during surgery for a retinal detachment resulting from a macular hole.

METHODS: A 62-year-old man who had a retinal detachment resulting from a macular hole underwent vitrectomy. During the surgery, intravitreal indocyanine green was injected intravitreally.

RESULTS: The internal-limiting membrane was stained green, but the epiretinal membrane was unstained. Because the epiretinal membrane and internal-limiting membrane were clearly identified, they could be completely removed. The clinical observations of the epiretinal membrane and internal-limiting membrane excised were confirmed by electron microscopy. Successful reattachment was obtained without damage to the retina.

CONCLUSION: Removal of epiretinal membrane and internal-limiting membrane can be facilitated by using intravitreal indocyanine green during vitrectomy. We recommend further studies to confirm the benefit of this technique.

References (3)

Y. Oshima et al.
Complete epiretinal membrane separation in highly myopic eyes with retinal detachment resulting from a macular hole
Am J Ophthalmol
(1998)

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

Cited by (72)

Does the Presence of an Epiretinal Membrane Alter the Cleavage Plane during Internal Limiting Membrane Peeling?
2010, Ophthalmology
To determine whether the presence of a clinically and/or microscopically detectable epiretinal membrane (ERM) alters the cleavage plane during internal limiting membrane (ILM) peeling.
Retrospective, observational, immunohistochemical study of ILM specimens using archival formalin-fixed, paraffin-embedded tissue.
Fifty-one patients who had had ILM excision.
Fifty-one ILM specimens peeled during vitrectomy for various etiologies were examined by light microscopy. The removal of ILM was assisted using Trypan blue (n = 30), indocyanine green (n = 7), or brilliant blue G (n = 14). Monoclonal antibodies to glial fibrillary acidic protein and to neurofilament protein were used to detect glial or neuronal cells respectively on the vitreous or retinal surfaces of the ILM. Specimens were divided into 2 groups: ILM peeled for full-thickness macular hole (MH; n = 31) and ILM peeled after removal of clinically detectable ERM (n = 20).
Primary outcome measure was the localization of immunohistochemical markers to neuronal or glial cells on the vitreous or retinal surfaces of ILM. The secondary outcome measure was the correlation of the results of the primary measure with the dyes used to facilitate ILM peeling.
Glial and/or neuronal cells were detected on the retinal surface of the ILM in 10 of 31 (32%) of the MH ILM specimens and in 13 of 20 (65%) of the ILM peeled after ERM excision; the difference was significant (P = 0.02). There was no association between the presence of neuronal and glial cells with the type of dye used (P = 0.2). Of the 23 ILM specimens with cells attached to the retinal surface, 21 (91%) were associated with clinical and/or histologic evidence of ERM and 2 (9%) were not. The correlation between the presence of cells on the vitreous and the retinal surfaces of ILM was high (P<0.0001).
The findings suggest that ERM may be associated with sub-ILM changes that alter the plane of separation during ILM peeling. This study does not confirm any influence of dyes on the cleavage plane during surgery.
The authors have no proprietary or commercial interest in any of the materials discussed in this article.
The Use of Vital Dyes in Ocular Surgery
2009, Survey of Ophthalmology
Citation Excerpt :
Kadonosono et al158 first described the use of viscoelatics for this purpose. Viscoelastic can be used to control where the dye settles on the retinal surface to avoid staining outside the macular region.34,197,317 Although good visual and anatomic outcomes could be achieved with this technique, it requires more surgical time.
Vital dyes have advanced diagnosis and surgical technique in various specialties, including oncology, gastroenterology, and ophthalmology. In ocular surgery vital dyes are widely used in cataract and vitreoretinal surgery. Worldwide, intra-operative use of trypan blue during cataract surgery has enhanced visualization of the anterior capsule during capsulorrhexis, and patent blue has been recently licensed in Europe for cataract surgery. For chromovitrectomy, the vital dyes indocyanine green, infracyanine green, and brilliant blue stain the internal limiting membrane, and trypan blue and triamcinolone acetonide help visualize epiretinal membranes and vitreous, respectively. Intra-operative vital dyes are finding uses in corneal, glaucoma, orbit, strabismus, and conjunctival surgery. We provide a summary of current knowledge of the use of vital dyes in ocular surgery. We review the properties of dyes, techniques of application, indications, and complications in ocular surgery. Vital dyes represent an expanding area of research, and novel dyes deserve further investigation.
I. Indocyanine Green Should Be Used to Facilitate Removal of the Internal Limiting Membrane in Macular Hole Surgery. Should Indocyanine Green Be Used to Faciliate Removal of the Internal Limiting Membrane in Macular Hole Surgery?
2009, Survey of Ophthalmology
Citation Excerpt :
Indocyanine green (ICG) was tested for macular hole surgery and was found to be an excellent way to stain the ILM. Initial reports were encouraging in the use of ICG for ILM peeling.9,13,17,18 The critical question is whether ICG can be used safely to stain and assist ILM removal.
Indocyanine green (ICG) is one of several vital dyes that are used in vitreoretinal surgery to aid visualization of diaphanous collagenous tissues in what has been called chromovitrectomy. As shown herein, much has been written about the use and rather narrow safety profile of ICG. The discussion surrounding its applications would have ended long ago were it not for the occasional patient who keeps returning to the office with permanent central scotomas after ICG-assisted macular hole surgery. The purpose of this Viewpoint is to reemphasize potential methods of proper use and clarify safety issues of this particular vital dye that enhances surgical technique but not necessarily visual outcome.
Residual Indocyanine Green Fluorescence Pattern after Vitrectomy with Internal Limiting Membrane Peeling in High Myopia
2007, American Journal of Ophthalmology
The use of indocyanine green (ICG) during intraoperative internal limiting membrane (ILM) peeling is common for various macular diseases. The authors observed residual ICG after vitrectomy for high myopia-related macular diseases and found a unique pattern specific to its pathologic features.
Observational case series.
Twelve eyes of 12 patients with high myopia who had undergone vitrectomy with ICG-assisted ILM peeling were included (macular hole [MH], six eyes; MH and retinal detachment, three eyes; and myopic foveoschisis, three eyes). Patterns of residual ICG were observed in the posterior retina using the Heidelberg Retina Angiograph 2 (Heidelberg Engineering, Heidelberg, Germany) after surgery and were compared. The minimum follow-up was six months. Two control eyes of two patients without intravitreal ICG also were included in this study.
The residual ICG fluorescence was observed in all eyes except for the control eyes. The pattern of residual ICG fluorescence depended on the degree of myopic chorioretinal atrophy. In eyes with no or minimum chorioretinal atrophy, the pattern was similar to that of an idiopathic MH. The ICG pattern was unique in those with moderate or severe atrophy. A strong ICG signal was observed at the area of diffuse atrophy and at the edge of the patchy atrophy and staphyloma. No ICG fluorescence was observed inside the patchy atrophy.
Residual ICG fluorescence was observed in high myopia. ICG accumulation seems to depend on the status of the retinal pigment epithelial (RPE) underlying the posterior retina. RPE cells may play an important role in the kinetics of the residual ICG.
Macular hole surgery with and without infracyanine-guided removal of the internal limiting membrane
2007, Journal Francais d'Ophtalmologie
Évaluer la possibilité d’un effet délétère du vert d’infracyanine sur les résultats fonctionnels de la chirurgie du trou maculaire.
Étude rétrospective de deux groupes successifs de patients opérés de trou maculaire entre janvier 1998 et décembre 2001. Dans le groupe 1, chez 21 patients, la limitante interne était laissée en place. Dans le groupe 2 (21 cas), elle était enlevée en utilisant le vert d’infracyanine.
Les trous maculaires ont été fermés en une intervention dans 17/21 cas (81 %) du groupe 1 et dans 20/21 cas (95 %) du groupe 2, l’écart n’étant pas significatif. L’acuité visuelle préopératoire moyenne était proche de 1 en LogMar dans les deux groupes. En postopératoire, elle était de 0,6 en LogMar dans le groupe 1 et de 0,5 dans le groupe 2, l’amélioration moyenne étant de 4 lignes Snellen dans le groupe 1 et de 5 lignes dans le groupe 2. L’acuité postopératoire était égale ou augmentée dans 16/21 yeux du groupe 1 et 18/21 cas du groupe 2. Ces différences n’étaient pas significatives. Le taux de réouvertures tardives était significativement moindre dans le groupe 2. Trois cas d’aspect d’atrophie de l’épithélium pigmentaire étaient notés dans chaque groupe et un aspect de phototraumatisme dans le groupe 1. Ces résultats sont restés stables avec un recul supérieur à 18 mois, les yeux sont tous devenus pseudophaques.
Dans cette étude, le pelage de la limitante interne aidé du vert d’infracyanine n’a pas amélioré statistiquement les résultats fonctionnels de la chirurgie du trou maculaire. En revanche, aucun effet délétère sur la fonction visuelle ni aucun effet toxique du vert d’infracyanine sur la rétine n’ont été relevés, et les réouvertures tardives ont été plus rares.
To investigate the possibility of an adverse effect of infracyanine-guided internal limiting membrane (ILM) removal on functional results of macular hole surgery.
A retrospective study of two consecutive groups of patients operated for macular hole between January 1998 and December 2001. In group 1 (21 patients), no attempt was made to remove the internal limiting membrane. In group 2 (21 patients), the ILM was peeled using infracyanine green (ICG).
In group 1, 17 of 21 (81%) macular holes were closed by one surgery and 20 of 21 (95%) in group 2; however, this was not statistically significant. Mean preoperative visual acuity was close to 1 on the Logmar scale in both groups. Postoperative visual acuity was 0.6 in group 1 and 0.5 in group 2: four Snellen lines of improvement in group 1 and five lines in group 2. Postoperative visual acuity was the same or better in 16 of 21 patients in group 1 and in 18 of 21 in group 2. These differences were not statistically significant. Late reopening of the hole was statistically less frequent in group 2. Three cases of atrophic patterns at the level of foveal pigment epithelium were noted in each group as was one case of phototraumatism in group 1. These results were stable after more than 18 months of follow-up. All eyes became pseudophakic.
In this study, infracyanine-guided removal of the internal limiting membrane did not significantly improve the results of macular hole surgery. No adverse effect of infracyanine on visual function or retinal toxicity was found and late reopening was less frequent.
Evaluation of efficacy and safety of new high-density dyes for chromovitrectomy
2021, Scientific Reports

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^☆: Supported by Grant-in-Aid 11771051 for Scientific Research from the Japanese Ministry of Education, Science, and Culture and by a grant for Research on Eye and Ear Science, Immunology, Allergy, and Organ Transplantation from the Ministry of Health and Welfare, Tokyo, Japan.

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Brief reportsIndocyanine green facilitates removal of epiretinal and internal limiting membranes in myopic eyes with retinal detachment☆

Abstract

Am J Ophthalmol

Brief reports
Indocyanine green facilitates removal of epiretinal and internal limiting membranes in myopic eyes with retinal detachment☆