The Use of Intraoperative Icg Dye to Assist in Epiretinal Membrane Removal; A Novel Application of Icg Surgical Use

Abstract

Purpose: : ICG dye has been used to stain the internal limiting membrane (ILM) and help facilitate it’s removal in vitrectomy surgery. We found that in the presence of epiretinal membranes there was a negative staining phenomenon. Our purpose is to describe the use of this to assist in visualization of ERM in macular surgery as well as to correlate intraoperative findings with Spectral Domain OCT.

Methods: : 49 consecutive eyes undergoing epiretinal membrane (ERM) removal and 10 eyes without ERM but undergoing ILM removal using ICG were reviewed from January 2006 to Sept 2008. In eyes with ERM, we used indocyanine green (ICG) staining to negatively stain the ERM. The presence or absence of staining intraoperatively was correlated with pre-operative OCT scans and clinical documentation of the presence of epiretinal membrane.

Results: : Of the 59 eyes in the study, 49 had evidence of negative staining of the ERM as the ICG dye stained areas of ILM which were not covered by ERM. We found two patterns of ICG staining in macular ERM; diffuse negative staining where the ERM covered the ILM completely and there was no green staining in the macular area and patchy staining where there appeared to be gaps in the ERM allowing the ICG to reach and stain the ILM. Corresponding pre-operative OCT scans showed definite ERM in the eyes corresponding with the area of negative staining intra-operatively. A control group of 10 eyes without ERM were also analyzed; eyes with uniform ICG staining of the retinal surface did not show ERM on SD OCT scans.

Conclusions: : We conclude that the use of ICG in eyes with subtle ERM enhances visualization of the membrane as the ERM blocks staining of the ILM causing a negative staining effect. This effect helps to clearly delineate the edges of ERM’s thus facilitating their surgical removal. ICG also may be useful in confirming the absence of ERM.

Keywords: vitreoretinal surgery • detection