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Nicklas B. Knudson, Christine Gonzales, MD, William Rodden, MD; Brilliant Blue G Vs. Indocyanine Green For Peeling Of Internal Limiting Membrane In Epiretinal Membrane Surgery. Invest. Ophthalmol. Vis. Sci. 2012;53(14):2634.
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© ARVO (1962-2015); The Authors (2016-present)
To compare the surgical outcomes of vitrectomy with internal limiting membrane (ILM) peeling for macular pucker with Brilliant Blue G (BBG) versus Indocyanine Green (ICG) staining.
Retrospective, comparative, study of consecutive patients from a single surgeon with idiopathic macular pucker (+/- VMT) that underwent 23 gauge vitrectomy surgery with ILM peeling using ICG or BBG staining with a follow-up of at least 3 months. The first consecutive 19 patients had ICG dye, and the next consecutive 18 had BBG dye. Visual data was converted to logMAR for statistical analysis and a conversion formula was used to account for the use of Cirrus and Stratus OCT data. Exclusion criteria included any additional ocular diagnosis that might confound OCT or visual acuity data.
Thirty seven eyes (19 OD, 18 OS) of 37 patients were included with a mean follow-up of 9.5 months (range 3-24 months) and mean age of 74 (range 59-89). Patient baseline characteristics were similar between the two groups, BBG vs. ICG, with the exception of mean follow-up (BBG=26.4 wks, ICG=56.0 wks, p<0.001) due to the consecutive nature of the study. With regards to visual acuity (logMAR), OCT central subfield thickness (microns), and OCT macular cubic volume (mm3), we found statistically significant improvement in all categories between pre-operative and post-operative data for both groups combined and each group independently (p<0.001 ). No statistical differences were found when the two groups were compared to each other for the same 3 outcome measures. Post-operative OCT morphology on the final visit was similar between the two groups and included: lack of foveal indentation (12 BBG, 13 ICG), good foveal indentation (3 BBG, 4 ICG), persistent CME (2 BBG, 2 ICG), and mild recurrent ERM (1 BBG, 1 ICG). Post-operative complications were not related to the dye in either group and included visually significant cataract (8 BBG, 7 ICG), occipital stroke (1 ICG) and loss of fixation secondary to glaucoma progression (1 ICG). Eight patients underwent cataract extraction surgery post-operatively (1 BBG, 7 ICG) and 7 patients received post-operative injections for CME (3 BBG, 4 ICG).
In this small retrospective study we found there to be no significant differences between BBG and ICG dyes with regards to visual acuity or OCT macular thickness and volume. Altered macular morphology (loss of foveal indentation) was similar in both groups and did not appear to have visual significance. There were no toxicity issues in either group; however, we did not evaluate autofluorescence, visual field testing, or electrophysiology.
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