Anatomic and visual outcomes after indocyanine green-assisted peeling of the retinal internal limiting membrane in idiopathic macular hole surgery

Ando, Fumitaka; Sasano, Kumiko; Ohba, Norio; Hirose, Hiroshi; Yasui, Osamu

doi:10.1016/j.ajo.2003.08.038

Cited by 109 publications

(107 citation statements)

References 19 publications

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“…C 3 F 8 gas was employed in 39 eyes, in 13 eyes SF 6 was used and in three eyes the intraoperative gas type used was not recorded. Table 1 shows the rates of 4) success in terms of anatomical closure and VA for the seven study factors: stage, duration, preoperative VA, simultaneous phacoemulsification and lens implant, ILM peel with or without the use of ICG, ILM peel with the use of ICG and postoperative prone posturing. Table 2 shows the estimates of the odds ratios (OR) associated with each study factor together with 95% confidence intervals (CI).…”

Section: Resultsmentioning

confidence: 99%

“…[14][15][16][17][18][19][20][21][22][23][24] However, there appears little doubt that in some circumstances ICG ILM peeling may be toxic to the retina with impaired acuity outcome, RPE pigmentary change and visual field defects being reported. [4][5][6][7][8][9][10]25 Factors that have been considered to be important in this toxicity include dye concentration, tonicity, contact time, and a photodynamic action associated with long wavelength endoillumination. We have used the dye at a concentration of 0.5 mg/ml (0.05%) diluted in 5 mg/ml in aqueous solvent and then one in 10 in BSS, with the shortest possible retinal contact time and use of a Bausch and Lomb Millenium or Alcon Accurus light source.…”

Section: Icg-assisted Ilm Peelingmentioning

confidence: 99%

“…2 This manoeuvre is greatly facilitated by the use of indocyanine green (ICG) dye; 3 there are, however, reports of adverse functional outcome when this dye has been used. [4][5][6][7][8][9][10] Nuclear sclerotic cataract is a very common complication of macular hole surgery, as a consequence of which some surgeons perform simultaneous 'prophylactic' clear lens extraction with lens implantation.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of macular hole surgery: implications for surgical management and clinical governance

Jaycock

Bunce

Xing

et al. 2004

Eye

102

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Purpose The optimal method and timing of the surgical treatment for idiopathic macular holes remains unknown. The aim of this retrospective study was to identify factors associated with anatomical and visual success in macular hole surgery. Methods Case records of 55 patients undergoing macular hole surgery at three units in the 2-year period up to July 2002 were reviewed to identify factors associated with anatomical and visual success. The following potential prognosticators were evaluated: patient age, hole stage, hole latency prior to surgery, preoperative acuity, simultaneous phacoemulsification, and intraocular lens implantation, internal limiting membrane peeling with and/or without indocyanine green, and postoperative posturing. Results The duration of preoperative symptoms, indocyanine green-assisted internal limiting membrane peeling, hole stage, and better preoperative visual acuity were associated with both anatomical success and regaining a postoperative visual acuity of 6/12 or better. Discussion The closure rate in patients undergoing surgery within 1 year of onset was 94.0%, and in those waiting 1 year or more it was 47.4%. Clinical governance and quality issues should dictate that NHS macular hole surgery is available to all within 1 year of onset. This study showed no adverse effect of ICG dye retinal staining. The results support the use of a 'patientfriendly' approach of simultaneous cataract surgery with no prone postoperative posturing.

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Section: Resultsmentioning

confidence: 99%

Section: Icg-assisted Ilm Peelingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outcomes of macular hole surgery: implications for surgical management and clinical governance

Jaycock

Bunce

Xing

et al. 2004

Eye

102

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“…[56][57][58][59] However, the use of ICG can be associated with poorer visual outcomes despite these high rates of anatomical closure. 48 Several series have reported high rates of anatomical closure, with no significant improvement in visual acuity [60][61][62][63] Moreover, the use of ICG has been associated with the development of irreversible peripheral nasal visual field defects, consistent with retinal nerve fibre damage involving predominantly the temporal retina. 60,61,63 The reasons for poor visual acuity and unexpected visual field defects associated with the use of ICG are not well understood, but mechanical, toxic, or phototoxic mechanisms may be involved.…”

Section: Peeling Of the Ilmmentioning

confidence: 99%

“…48 Several series have reported high rates of anatomical closure, with no significant improvement in visual acuity [60][61][62][63] Moreover, the use of ICG has been associated with the development of irreversible peripheral nasal visual field defects, consistent with retinal nerve fibre damage involving predominantly the temporal retina. 60,61,63 The reasons for poor visual acuity and unexpected visual field defects associated with the use of ICG are not well understood, but mechanical, toxic, or phototoxic mechanisms may be involved. Analysis of ILM peeled after ICG staining has demonstrated adherence of additional retinal elements including remnants of Mü ller cell footplates, neuronal cells, and ganglion cells, suggesting that ICG may alter the cleavage plane to involve the innermost retinal layers.…”

Section: Peeling Of the Ilmmentioning

confidence: 99%

Macular holes: vitreoretinal relationships and surgical approaches

Bainbridge

Herbert

Gregor

2008

Eye

100

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Idiopathic full-thickness macular holes develop as a result of anteroposterior and tangential traction exerted by the posterior vitreous cortex at the fovea. Vitreoretinal relationships during the development of macular holes can be demonstrated in detail by ocular coherence tomography, facilitating an improved understanding of their pathogenesis and guiding clinical management. Surgical strategies for the repair of macular holes are designed to relieve vitreofoveal traction and to promote flattening and reapposition of the macular hole edges by intraocular gas tamponade. A period of facedown positioning postoperatively is conventionally advised. However, the evidence to support this recommendation is weak and practice varies considerably. Surgical removal of the inner limiting membrane (ILM) is advocated to ensure thorough removal of any tangential tractional components including any residual cortical vitreous. Current evidence suggests that ILM peeling can improve anatomical outcomes but the effect on visual function is less predictable; unsuccessful attempts to peel the ILM can be associated with poor visual outcome. The use of vital dyes can facilitate visualisation of the ILM and help achieve complete, atraumatic peeling. Indocyanine green dye can enable high rates of macular hole closure but has been associated with poorer visual outcomes suggesting a dosedependent toxicity. Trypan blue dye offers an alternative that may have a more favourable risk profile. An improved understanding of vitreoretinal relationships may facilitate a tailored approach to surgery in individuals with macular holes. Vitrectomy to relieve anteroposterior traction is central in the management of all full-thickness holes. The use of long-acting gases, prolonged face-down positioning, and ILM peeling may be more valuable for larger holes, longstanding holes, and those that have failed to close following conventional surgery.

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Internal Limiting Membrane Peeling With Indocyanine Green or Trypan Blue in Macular Hole Surgery

Beutel

G²,

Ziegler³

et al. 2007

Arch Ophthalmol

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Anatomic and visual outcomes after indocyanine green-assisted peeling of the retinal internal limiting membrane in idiopathic macular hole surgery

Cited by 109 publications

References 19 publications

Outcomes of macular hole surgery: implications for surgical management and clinical governance

Outcomes of macular hole surgery: implications for surgical management and clinical governance

Macular holes: vitreoretinal relationships and surgical approaches

Internal Limiting Membrane Peeling With Indocyanine Green or Trypan Blue in Macular Hole Surgery

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