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Vincent Y Ho, G Baker Hubbard, gaurav shah, Steven Yeh, Timothy W Olsen; Comparison of Visual and Anatomic Outcomes When Using ICG or Kenalog During Macular Hole Surgery. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5079.
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© ARVO (1962-2015); The Authors (2016-present)
Internal limiting membrane (ILM) peeling during macular hole (MH) surgery increases closure rates. Visualizing the ILM can be difficult so adjuncts like indocyanine green (ICG) and kenalog are often used during surgery. Studies of ICG-assisted peeling report decreases in visual outcomes raising concerns for possible toxicity. Meanwhile, kenalog-assisted peeling has been shown to have less than expected effects of cataract formation and intraocular pressure. This study compares visual and anatomic outcomes to determine which agent is safer and more effective during MH surgery with ILM peel.
Retrospective, nonrandomized, interventional comparative review comparing MH surgery with ILM peel between January 1, 2003 and December 30, 2013. 817 patients and 832 eyes were reviewed. Inclusion criteria included presence of MH and pars plana vitrectomy (PPV) with kenalog or ICG-assissted ILM peel during MH surgery. Exclusion criteria included follow-up< 3 months, traumatic MH, recurrent MH, myopia >8 diopters, prior vitreoretinal surgery or ocular pathology affecting visual acuity. Patients of 10 experienced vitreoretinal surgeons were analyzed. Standard 3 port 20-, 23-, or 25-gauge PPV with nonexpansile, inert gas tamponade were performed with facedown positioning up to 7 days. Primary outcomes at Months 1, 3, 6, 12 included hole closure and visual acuity.
A total of 293 ICG-assisted and 94 kenalog-assisted eyes were included. In the ICG group, the average age was 67.0 ± 7.6 years, mean minimum diameter was 290 ± 183 microns, and MH stages (Gass classification) were I: 4 (2%), II: 55 (22%), III: 151 (60%), IV: 41 (16%). In the kenalog group, the average age was 66.2 ± 7.5 years, mean minimum diameter was 280 ± 182 microns, and MH stages were I: 3 (4%), II: 27 (39%), III: 28 (41%), IV: 11 (16%). At postoperative month 12, MH closure rates were 141 (98%) with ICG and 51 (96%) with kenalog, p=0.61. While mean preoperative visual acuity was 0.70 logMAR in both groups, visual outcomes were similar at month 12, 0.30 (ICG) and 0.40 (kenalog), p=0.11.
Early reports of MH surgery reported improved closure rates with ILM peeling. Our study shows similar MH closure rates and visual acuity outcomes in ICG and kenalog-assisted groups.
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