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J.R. Gonder, J.S. Gale; Macular Hole Surgery Outcomes: ILM Peeling with Compared to without ICG Dye . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4868.
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Purpose: Indocyanine green (ICG) dye is employed to assist in the peeling of the internal limiting membrane (ILM) during macular hole surgery. Debate exists surrounding visual outcome, macular hole closure and reopening rates with the advent of ICG. We compared outcomes of patients undergoing macular hole surgery with and without ICG dye assistance. Methods: A retrospective review of 173 consecutive eyes (158 patients) that underwent macular hole surgery between January 1993 and August 2002 by one surgeon . All patients had had three-port pars plana vitrectomy, air-fluid exchange and C3F8 gas injection. ICG dye assisted ILM peeling was performed 78 eyes of 75 patients (ICG 0.5mg/ml for less than a 60 second exposure). ILM peeling was not performed in 95 eyes (83 patients). Mean follow-up for the group that received ICG dye was 10 months vs. 28 months in the no ICG group. Results: The ICG and no ICG groups were comparable in terms of macular hole duration and stage, lens status and preoperative visual acuity. The macular hole failed to close in 2 cases (2.56%) in the ICG group vs. 19 cases (20.00%) in the no ICG group (p<0.01). Reopening of the macular hole did not occur in the ICG group; however, 9 (9.47%) macular holes reopened in the no ICG group (p<0.01). Pigmentary changes in the foveal retinal pigment epithelium occurred in 2 eyes (2.56%) that received ICG dye. Postoperative visual acuity was similar in the 2 groups. Analysis of visual outcomes was performed on patients who were pseudophakic, 33 eyes in the ICG group and 58 eyes in the no ICG group. In the ICG group compared with the no ICG group, there was a gain of 5.5 vs. 5.7 lines of best-corrected Snellen visual acuity, better than 20/40 best-corrected Snellen visual acuity in 21 eyes (63.64%) vs. 40 eyes (68.97%), and worse than 20/60 best-corrected Snellen visual acuity in 6 eyes (27.27%) vs. 5 eyes (12.50%). None of these differences were statistically significant (p>0.05). Conclusions: ICG assisted ILM peeling improved macular hole closure and reduced macular hole reopening. The use of ICG dye did not have any statistically significant detrimental effect on postoperative visual acuity.
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