Modified Technique for Safer Indocyanine Green-Assisted Peeling of the Retinal Internal Limiting Membrane During Vitrectomy Surgery for Macular Hole Repair

Abstract

Abstract: : Purpose: To determine the efficacy of Autologous Whole Blood (AWB) injection to prevent Indocyanine Green (ICG) - related dameges during ICG-assisted retinal internal limiting membrane (ILM) peeling for macular hole repair. Methods: 26 consecutive eyes of 26 patients, with stage 2-3-4 macular holes (Mean Visual Acuity 20/150) underwent pars plana vitrectomy with mechanical posterior vitreous detachment.A.W.B. (0.1 ml.) was instilled over the macula and removed after 30 seconds to avoid coagulation. ICG (0.2 ml with 0.05% concentration in 0.4 ml. glucose 5%) was then instilled over the macula and removed after 20 seconds. The stained retinal ILM was peeled. Long-acting gas tamponade (C3F8 14%) was used in all cases and all patients were asked to position face-down for 10 days. OCT and fluorangiography were performed pre and postoperatively. Results: ICG greatly facilitated the surgery in all cases. Patients were observed after surgery for an average 7 months (range 2-24 months). OCT showed in all eyes the anatomical closure of the macular hole, achieved in 23 eyes (88%) with a single surgery. Visual acuity improved more then 2 lines in 25 of 26 eyes (96%) after surgery. There was no clinical, OCT or fluorescein angiographic evidence of atrophic or hypertrophic changes of retinal pigment epithelium. Conclusions: ICG staining of the retinal ILM facilitates ILM peeling. AWB may act as a mechanical barrier against damages due to ICG. Reducing the conctact time of ICG and retina, and avoding the air exchange may also be useful: therefore modified ICG staining of the ILM appears to be a safe and useful option in vitreous surgery for macular hole repair.

Keywords: retinal detachment