Elsevier

Ophthalmology

Volume 111, Issue 12, December 2004, Pages 2246-2253
Ophthalmology

Original article
Long-term follow-up of indocyanine green–assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for idiopathic macular hole repair

https://doi.org/10.1016/j.ophtha.2004.05.037Get rights and content

Objective

To determine the long-term efficacy of indocyanine green (ICG)–assisted retinal internal limiting membrane (ILM) peeling during macular hole repair.

Design

Retrospective, interventional, noncomparative case series.

Participants

One hundred twenty-one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG-assisted macular hole repair during the period of August 1999 to January 2003.

Intervention

All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long-acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks.

Main outcome measures

Long-term postoperative anatomic results, visual acuity (VA), and complications.

Results

Patients were observed postoperatively for an average of 26 months (range, 12–53). Anatomic closure of the macular hole was achieved in 118 eyes (98%) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by ≥2 lines in 116 eyes (96%). Mean visual improvement after surgery was 6 lines (range, 0–14), and 96 eyes (79%) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG.

Conclusions

Long-term follow-up of patients who underwent ICG-assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.

Section snippets

Patient selection

Patients who presented to the retinal service at the Cincinnati Eye Institute with a stage 2, 3, or 4 idiopathic macular hole were considered for entry into our study. Inclusion criteria were an unequivocal stage 2, 3, or 4 idiopathic macular hole; a desire for surgery to attempt hole closure; and clinical follow-up of at least 1 year. Exclusion criteria included diabetic retinopathy and previous intraocular surgery, except for uneventful cataract extraction.

There were 16 eyes from our initial

Results

One hundred fourteen patients (121 eyes) with stage 2, 3, or 4 idiopathic macular holes were enrolled. The average age of the patients was 69 years (range, 51–85). Idiopathic stage 2 macular holes were present in 14 eyes (12%). Idiopathic stage 3 macular holes were present in 85 eyes (70%). Idiopathic stage 4 macular holes were present in 22 eyes (18%). The median reported macular hole duration was 3 months (range, 1–120). At the time of vitrectomy surgery, 29 eyes (24%) were pseudophakic, 56

Discussion

The purpose of this study is to report our long-term experience and outcomes with intraoperative ICG-assisted peeling of the retinal ILM for macular hole repair. To minimize the effects of confounding variables, we report herein only patients who met the selection criteria of unequivocal idiopathic stage 2, 3, or 4 macular holes; no diabetic retinopathy; and completion of at least 1 year of follow-up. As such, this article includes outcomes for some but not all of the patients reported in our

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    Manuscript no. 240089.

    The authors received no public or private financial support pertaining to the information published in this article.

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