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Residual indocyanine green fluorescence pattern after vitrectomy for idiopathic macular hole with internal limiting membrane peeling
  1. Kaori Sayanagi,
  2. Yasushi Ikuno,
  3. Kaori Soga,
  4. Miki Sawa,
  5. Yusuke Oshima,
  6. Motohiro Kamei,
  7. Shunji Kusaka,
  8. Yasuo Tano
  1. Department of Ophthalmology, Osaka University Medical School, Suita, Japan
  1. Correspondence to: Dr Y Ikuno Department of Ophthalmology E7, Osaka University Medical School, 2-2 Yamadaoka, Suita 565-0871, Japan; ikuno{at}


Background: Internal limiting membrane (ILM) peeling with indocyanine green (ICG) staining is a commonly used procedure to treat idiopathic macular holes (MH).

Aim: To report changes in the patterns of residual ICG fluorescence over time after vitrectomy using the Heidelberg Retina Angiograph 2 (HRA2, Heidelberg Engineering, Heidelberg, Germany).

Methods: 10 patients (10 eyes) who had undergone vitrectomy for MH with ILM peeling were included. 9 (90%) patients underwent ILM peeling with ICG, and 1 (10%) patient had it with triamcinolone acetonide (TA). We observed residual ICG using HRA2, postoperatively. Autofluorescence, optical coherence tomography images and best-corrected visual acuity (BCVA) measurements were also obtained. The minimal follow-up was 3 months.

Results: The MHs were closed postoperatively in all patients (100%). In eyes that underwent ILM peeling with ICG, the BCVA improved significantly (p<0.001) in 8 (89%) eyes and was unchanged in 1 (11%) eye. HRA2 showed the ICG fluorescence patterns but not TA postoperatively. The ICG hyperfluorescent signal was typically diffuse at the posterior retina and was hypofluorescent around the fovea. The hyperfluorescence then migrated towards the optic nerve disc presumably along the nerve fibre, 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.

  • BCVA, best-corrected visual acuity
  • BSS, balanced salt solution
  • FA, fluorescein angiography
  • HRA2, Heidelberg Retina Angiograph 2
  • ICG, indocyanine green
  • ILM, internal limiting membrane
  • MH, idiopathic macular hole
  • NFL, nerve fibre layer
  • OCT, optical coherence tomography
  • RPE, retinal pigment epithelium
  • TA, triamcinolone acetonide

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  • Published Online First 10 January 2007

  • Funding: This study was supported by grant No 16591750 from the Ministry of Education, Culture, Sports, Science, and Technology of Japan and a grant from Health and Labor Sciences Research of Japan.

  • Competing interests: None.