Visual outcomes following ICG assisted ILM peel for Macular Hole

Abstract

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.

Combined phacoemulsification and pars plana vitrectomy for macular hole treatment

“…Secondly, the authors used indocyanine green (ICG) as a dye for assisting internal limiting membrane (ILM) peeling in all their patients. While we agree that ICG provides effective staining of the ILM, since 2004 an increasing number of studies have reported the toxic effects of ICG on the retina, which include retinal pigment epithelial changes and optic atrophy (Cheng et al 2005; Posselt et al 2005). We would like to know if the authors have observed any similar toxic effects that may have been induced by ICG in their series of patients.…”

Peel and peel again

“…In situations where the surgeons are uncertain if the ILM was removed in part or completely, it made sense to use ICG. There are, however, serious concerns about the possible toxic effect of ICG 12 13. TB is not specific in that it stains both ERM and ILM.…”

Trochlear displacement by orbital plexiform neuroma: a novel mechanism causing superior oblique underaction

“…We have previously reported our experience with ICG-assisted ILM peel. 2 Our patients achieved a high rate of anatomical hole closure but visual results were disappointing. As a result of these findings we performed an audit of macular hole surgery in our department.…”