Functional and anatomic results of macular hole surgery complicated by massive indocyanine green subretinal migration

Abstract

Abstract: : Purpose: To report the functional and anatomic results of macular hole (MH) surgery complicated by massive indocyanine green (ICG) subretinal migration Methods: We performed pars–plana vitrectomy surgery for a stage III, senile idiopathic MH. After posterior vitreous detachment and vitreous removal we instilled 2ml of ICG (0.5%, 270mOsm); the surgery was complicated by diffuse subretinal migration of the dye but the ILM peeling was performed (despite the obvious difficulties from low contrast between the green stained ILM overlying a green–stained subretinal space, Figure 1) and the rest of the procedure was completed with final injection of 16% C₃F₈. Results: Optical coherence tomography showed the anatomic closure of the MH. Digital photography with the excitation and barrier filters for ICG showed a striking autofluorescence along the inferior vascular arcade which remained intense even 7 months after surgery. Despite the ICG subretinal migration VA improved to 20/30 Conclusions: This is the first report of VA recovery despite massive ICG subretinal migration during MH surgery. Despite the ongoing research on ICG toxicity, reported toxicity results on humans are still controversial. Subretinal migration of ICG dye is a potential complication of MH surgery, that should limit its use, despite the absence of clinically apparent adverse events.  

Keywords: drug toxicity/drug effects • vitreoretinal surgery • macular holes