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R.G. Williams, J.Y. Wong, J.R. Gonder; Outcomes of Macular Hole Surgery With and Without the Use of Indocyanine Green Dye . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5466.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the anatomical and visual outcome of macular hole surgery using pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling with and without indocyanine green (ICG)–assisted visualization. Methods: A retrospective, comparative, consecutive study of 148 patients (154 eyes) presenting with an idiopathic macular hole at two separate retinal surgeon practices between 1998–2002 were included in this study. The final analysis included 132 patients (138 eyes) who underwent vitretomy and ILM peeling; Group I (76 eyes) without the use of ICG and Group II (62 eyes) with ICG–assisted peeling. A single surgeon performed the operation for each group. For the ICG–assisted removal of the ILM, a 0.5 mg/mL solution was used for a staining time of 30 seconds followed by washout. The main outcome measures were post–operative visual acuity and anatomical closure of the macular hole. Patients with inadequate follow–up (< 3 months), macular holes secondary to trauma, previous retinal surgery, and pre–existing vitreoretinal pathology were excluded. Differences in baseline characteristics including age, sex, pre–operative visual acuity, symptom duration and stage of the macular hole were adjusted for in the final analysis. Results: Anatomical closure rates were comparable with 97.1% of the macular holes closed with one operation. In the non–ICG group, 74 of 76 (97.4%) eyes in the non–ICG group and 60 of 62 (96.8%) eyes in ICG group. Using a multiple regression analysis, we found a mean difference in lines of visual improvement of +1.60 (P = 0.008) in favor of the ICG–assisted group. However, this difference was not statistically significant after adjusting for baseline group differences, with a final mean difference in lines of improvement of 0.09 lines (P = 0.836). No toxicity related changes were noted on post–operative exam in the ICG group. Complications included 4 retinal detachments, 2 in each group, with subsequent re–operation. The rate of cataract progression in each group was similar, with 68/138 (49.3%) eyes requiring cataract extraction post–operatively. Conclusions: Indocyanine green dye assists in visualization and peeling of the internal limiting membrane. In this study, closure rates and visual outcomes with and without the use of ICG in ILM peeling are comparable.
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