Toxic effect of indocyanine green on retinal pigment epithelium related to osmotic effects of the solvent

Stalmans, Peter; Aken, Elisabeth Van; Veckeneer, Marc; Feron, Eric J.; Stalmans, Ingeborg

doi:10.1016/s0002-9394(02)01468-x

Cited by 158 publications

(114 citation statements)

References 5 publications

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“…[2][3][4][5][6] However, recent studies have suggested less favourable functional results, and histopathologic analysis of operative 9 and cell culture 10,11 specimens has suggested that ICG may be toxic to the retina. Our observations during this study support these findings.…”

Section: Discussionmentioning

confidence: 99%

“…Increased cell death 11 and reduced mitochondrial enzyme activity 10 have been demonstrated in cultures exposed to ICG compared with those exposed to control solutions such as phosphatebuffered solution (PBS) or balanced salt solution (BSS). These changes relate to the clinical findings, as ICG comes in direct contact with the RPE through the macular hole during staining.…”

Section: Discussionmentioning

confidence: 99%

“…1 It is a technically demanding procedure, and many surgeons prefer to stain the membrane with indocyanine green (ICG) to provide contrast and facilitate peeling, resulting in high anatomical success rates. [2][3][4][5][6] Recent clinical 7,8 and histopathological [9][10][11] studies have suggested that ICG may be toxic to the retina. We assessed anatomical and functional results of ICG-assisted ILM peel for macular hole and attempted to identify potential factors that may affect the outcome of the procedure through a search of the literature.…”

Section: Introductionmentioning

confidence: 99%

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Visual outcomes following ICG assisted ILM peel for Macular Hole

Posselt

Rahman

Smith

et al. 2004

Eye

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Purpose To evaluate the anatomical and visual outcome of indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling for macular hole surgery. A literature search identified potential factors that may affect the functional success of the procedure. Methods Retrospective case note review of 14 consecutive patients undergoing phacovitrectomy, gas and ICG-assisted ILM peeling for macular hole from July 2001 to July 2002. A 0.5% ICG solution (osmolarity 270 mOsm) was left in contact with the retina for 1-3 min. The outcome measures were hole closure, change in visual acuity, and macular pigmentary changes. Results Anatomical hole closure was achieved in 13 of 14 eyes (92.8%). The mean logMAR Snellen acuities were 0.80 (range 0.60-1.30) preoperatively and 0.77 (0.48-1.30) postoperatively. Seven eyes (50%) developed retinal pigmentary changes in the macular area Conclusions ICG-assisted ILM peeling for macular hole surgery achieves high rates of anatomical hole closure, but functional results are less encouraging. Previous studies suggest toxicity of the ICG to the retina, at the level of the RPE or inner retina. The results may be optimized by using a lower concentration, isoosmolar, viscous solution, and by minimizing contact time of the solution and intensity, and duration of illumination.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Visual outcomes following ICG assisted ILM peel for Macular Hole

Posselt

Rahman

Smith

et al. 2004

Eye

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“…In macular surgery, the surgical approach to ILM-removal has become increasingly important. Since ILM-peeling is technically difficult, the risk for retinal damage is high, and possible retinal toxicity caused by ICG-staining is discussed [11][12][13], there is a need for a quick, reproducible, and safe alternative method to mechanical peeling.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a technique for reliable intraoperative identification and less traumatic removal of the ILM was introduced that makes use of indocyanine green (ICG) or trypan blue staining of the ILM [10]. However, due to newly reported side effects [11][12][13] and uncertainties about possible retinal toxicity of ICG there is still a need for atraumatic way of ILM-removal.…”

Section: Introductionmentioning

confidence: 99%

Photoablation of inner limiting membrane and inner retinal layers using the Erbium:YAG‐laser: An in vitro study

Hoerauf¹,

Brix²,

Winkler³

et al. 2005

Lasers Surg Med

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Background and Objectives: To explore the potential of Er:YAG-laser irradiation for precise and tractionless retinal tissue and inner limiting membrane ablation. Materials and Methods: We used free-running Er:YAGlaser irradiation (l ¼ 2.94 mm) transmitted either through a 10 cm long low-OH-quartz fiber or a 2 m long sapphire fiber that produced a more homogenous light distribution at the fiber tip. Retinal ablation in porcine retinal explants was performed under air or perfluorodecaline (PFD). Ablation depth was evaluated by optical coherence tomography (OCT) and from histologic sections. Results: A radiant exposure of 5.0 J/cm 2 delivered through a low-OH-quartz fiber and PFD caused a complete transsection of the neurosensory retina. Radiant exposures between 3.5 and 2.0 J/cm 2 resulted in marked variations of ablation depth and adjacent thermal damage. By contrast, laser pulses of 4.0 and 3.0 J/cm 2 transmitted through the sapphire fiber produced more homogenous defect patterns and less thermal damage. Close to the ablation threshold, with 1.0-2.0 J/cm 2 , ablation was limited to a 10-20 mm thin layer of the neural retina. Conclusions: We achieved in vitro ablation of inner retinal layers, but could not produce selective and reproducible ILM removal.

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