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Khushboo K. Agrawal, Ravi D. Patel, Rama D. Jager; Macular Schisis Following Indocyanine Green-Assisted Internal Limiting Membrane Peel for Epiretinal Membrane Surgery. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4482. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate potential macular toxicity secondary to indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling during epiretinal membrane (ERM) surgery using spectral domain optical coherence tomography (SD-OCT).
A retrospective review of 11 eyes of 11 patients that underwent combined ERM/ILM peeling using a 2.5 mg/mL dose of ICG dye (timed for one minute against the clock) for membrane visualization between July 2008 and April 2010, by a single surgeon (RDJ). Preoperative best corrected visual acuity (BCVA), central macular thickness (CMT) and SD-OCT (Spectralis®, Heidelberg Engineering) macular structural appearance were compared with the same parameters at postoperative months one, three and six.
Six of eleven patients were male. Mean patient age was 75.45 years. Mean preoperative logarithm of the minimum angle of resolution visual acuity (LogMAR VA) was 0.95 (20/200) with a range of 0.4 to 1.7 (20/50 to 20/1000). Mean postoperative LogMAR VA at 6 months was 1.32 (20/400) with a range of 0.4 to 2.6 (20/50 to 20/8000). With a p value of 0.16, there was no statistically significant relationship between pre- and post-operative BCVA. In addition, mean CMT on SD-OCT was 402.27 microns preoperatively and 354.0 microns at 6 months postoperatively, with a statistically insignificant p value of 0.21. However, and most notably, SD-OCT imaging revealed the presence of macular schisis as early as 1 month postoperative, and was present in each of 11 patient images. This finding could not be explained by any coexisting ocular comorbidities.
ICG associated retinal toxicity is undoubtedly a controversial subject of several in vivo and in vitro studies. Our findings suggest that macular schisis may represent a previously unknown adverse effect of this dye. Further controlled studies are warranted to investigate the in vivo effect of ICG on retinal morphology and visual acuity.
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