Postoperative sterile inflammation after pars plana vitrectomy with indocyanine green

Abstract

Purpose : Indocyanine green (ICG) is commonly utilized in an off-label fashion as an adjuvant during vitreoretinal surgery. This dye can highlight the internal limiting membrane to improve visualization for peeling during pars plana vitrectomy (PPV). We report four cases of severe, but sterile, post-operative inflammation likely secondary to the use of intraoperative ICG.

Methods : Retrospective chart review of cases in a retina-only group practice. A search of medical records was conducted to identify adult patients with severe inflammation following pars plana vitrectomy.

Results : During the study period, 241 eyes underwent PPV. In 165 of those cases, intraoperative ICG was utilized. Four of those eyes (4/241 or 1.6%) presented with severe inflammation, involving the anterior and posterior segments of the eye, one day following surgery. The findgins included different degrees of iritis, hypopyon, fibrin in the anterior chamber, vitritis (n = 4) and intraretinal hemorrhages (n =1). All four (100%) received ICG from the same lot number (Akorn Inc. Lot #: 031010); no cases were seen from other lot numbers (p<0.0001, Fisher’s Exact Test). The cases involved multiple surgeons across multiple dates. The vitreous specimen that was collected did not grow any organisms. High performance liquid chromatography with ultraviolet detection (HPLC-UV) was performed on a sample from the affected lot of ICG dye. In all four cases, post-operative inflammation resolved with topical steroids within 1 week.

Conclusions : The off-label intraoperative use of ICG dye as a surgical adjuvant during vitreoretinal surgery with epiretinal membrane peeling may rarely be associated with severe but sterile post-operative inflammation All cases of inflammation resolved with frequent topical steroids within 1 week. Vitreoretinal surgeons should be aware of the possibility of sterile inflammation following the use of ICG.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.