Abstract
Purpose :
The authors highlight the use of indocyanine green (ICG) lymphangiography in evaluating eyelid and facial lymphatics.
Methods :
A prospective IRB-approved study was conducted from 2021 – 2022. Subcutaneous injection of 0.03–0.06 mg of ICG was given in the pretarsal orbicularis of the upper or lower, medial or lateral, eyelid to visualize lymphatic drainage. Fluorescent lymphatic uptake was captured in real-time video using SPY PHI SystemTM (Stryker, Kalamazoo, MI) or EleVisionTM IR Platform (Medtronic, Minneapolis, MN) over 30 minutes. Lymphatic function was assessed by number of lymph channels and transit time from injection site to regions of interest.
Results :
Lymphangiography analysis was performed on 11 patients, 64% males and included 14 total injections.[TVA1] Three patients had injections of multiple eyelids. Lymphatic channels were seen in 72% of patients. Lymphatic mapping revealed two channels on the upper lid and one to two channels on the lower lid. Mean travel time of the lymphatics was mapped in 12 patients to the lateral canthus, midface, and respective lymph node. Injection of the medial upper lid (n=3) drained to the lateral canthus (2.1 minutes), midface (12.5 min), and the submandibular node (23 min). The lateral upper lid (n=4) drained to the lateral canthus (1.2 min), midface (3.1 min), and the preauricular node (10.7 min). The medial lower lid (n=3) reached the lateral canthus (3.8 min) and midface (7.9 min). The lateral lower lid (n=2) reached the lateral canthus (1.9 min), midface (11 min), and preauricular node (1.3 min). Lymphatic flow accelerated with blinking or forceful contraction of the orbicularis muscle. One patient with clinical lymphedema of the eyelids of unknown etiology revealed lymphostasis after monitoring for 20 minutes. Fluorescence at the respective nodes was barely perceptible after 60 minutes. Most common side effects included injection site pain and temporary green subcutaneous staining which resolved within a few days. Of the patients that could not complete lymphatic mapping, 77% were under general anesthesia with muscle relaxation.
Conclusions :
The authors highlight a protocol using ICG to assess the periorbital and facial lymphatics. Further research with lymphangiography in lymphatic function using ICG is needed.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.