Effect of Indocyanine Green Dye on the Visual Outcomes in Macular Hole Surgery with Internal Limiting Membrane Peeling

Abstract

Abstract: : Purpose: Several reports have suggested toxicity of indocyanine green (ICG) dye used for internal limiting membrane (ILM) peeling. The purpose of this study is to determine the effect of indocyanine green (ICG) dye on visual outcomes in macular hole surgery. Methods: Prospective, randomized, consecutive series. Forty-six eyes underwent pars plana vitrectomy with ILM peeling and were followed for more than 6 months (mean 11.4 months). In 22 eyes ICG-assisted peeling of the ILM was performed; ICG(+) group. In the remaining 24 eyes, ILM was peeled without ICG; ICG(-) group. For ILM staining, 0.125 % ICG solution was injected into the vitreous cavity over the macular and was aspirated immediately. The best-corrected visual acuity after surgery was converted to log MAR for statistical analysis. Results: There were no differences in preoperative visual acuity, size of MH, stage of MH, age, or follow-up period. No difference was found in postoperative visual acuity between ICG(+) group, ranging from 20/100 to 20/16 (mean 0.66), and, ICG(-) group, ranging from 20/100 to 20/16 (mean 0.72) using Mann-Whitney U-test (P=0.57). We found no difference in visual acuity improvement between ICG(+) group and ICG(-) group using unpaired t-test (-0.74±0.31 vs –0.70±0.26 in log MAR, respectively, P=0.67). In all eyes, postoperative visual acuity was higher than preoperative visual acuity by 2 or more lines. No atrophic retinal pigment epithelium change was found using an ophthalmoscope. Conclusions: In our series, we found little effect of ICG dye on visual acuity after more than 6-month follow-up period. Toxicity of ICG may depend on many factors, such as the concentration of ICG, exposure time, and surgical techniques and instruments.

Keywords: macular holes • vitreoretinal surgery