Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair

Mata, Andrea P Da; Burk, Scott; Riemann, Christopher D.; Rosa, Robert H.; Snyder, Michael E.; Petersen, Michael R.; Foster, Robert E.

doi:10.1016/s0161-6420(01)00593-0

Cited by 275 publications

(197 citation statements)

References 28 publications

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“…[6][7][8][9][10][11] With additional use of ICG-assisted ILM peeling, success rates of 87.8 and 88% have been reported. 12,13 No published series of cases with ILM peeling, with or without ICG, has contained a control group. Our series, although retrospective, has attempted to provide control data.…”

Section: Discussionmentioning

confidence: 99%

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Outcome of ICG-assisted ILM peel in macular hole surgery

Lochhead¹,

Jones²,

Chui³

et al. 2004

Eye

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Purpose To investigate whether indocyanine green (ICG) staining of the internal limiting membrane (ILM) improves surgical outcome. Methods A total of 34 patients were identified who underwent macular hole surgery with ILM peeling augmented with ICG. These were matched retrospectively with 34 patients who underwent macular hole surgery without the use of ICG. Closure rates from primary and secondary procedures were compared, as were changes in Snellen and Logmar visual acuity. Results There was no significant difference between the two groups with reference to demographic features of age, sex, staging of the macular holes, and the proportion subsequently undergoing cataract surgery. The mean follow-up period was 7.7 months in the ICG group and 6.3 months in the non-ICG group. Closure rates from primary surgery were 91.2% in the ICG group and 73.5% in the non-ICG group (P ¼ 0.056), whereas overall closure rates following further surgery were similar in both groups (94.1 and 91.2%, respectively). Logmar visual improvement above baseline was achieved in 53% of the non-ICG group compared to 82% of the ICG group (P ¼ 0.01). Where primary hole closure occurred, there was no statistically significant difference in visual outcome between the two groups. Conclusion ICG-assisted ILM peel in macular hole surgery is associated with a higher closure rate following a single surgical procedure. This difference was found to approach statistical significance (P ¼ 0.056). Overall visual improvement was greater in the ICG group (P ¼ 0.01); however, this reflected the higher closure rates. Visual outcomes between the two groups were comparable where primary hole closure occurred.

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Section: Discussionmentioning

confidence: 99%

“…Indocyanine green (ICG) is used as an adjunct to the surgery enabling visualisation of the ILM. 12,13 Whether ICG toxicity is clinically significant is controversial. Our study attempts to address this issue using a case-control analysis of macular hole surgery at a UK-based teaching hospital.…”

Section: Introductionmentioning

confidence: 99%

Outcome of ICG-assisted ILM peel in macular hole surgery

Lochhead¹,

Jones²,

Chui³

et al. 2004

Eye

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“…[14][15][16][17][18][19][20][21][22][23][24] However, there appears little doubt that in some circumstances ICG ILM peeling may be toxic to the retina with impaired acuity outcome, RPE pigmentary change and visual field defects being reported. [4][5][6][7][8][9][10]25 Factors that have been considered to be important in this toxicity include dye concentration, tonicity, contact time, and a photodynamic action associated with long wavelength endoillumination.…”

Section: Icg-assisted Ilm Peelingmentioning

confidence: 99%

Outcomes of macular hole surgery: implications for surgical management and clinical governance

Jaycock

Bunce

Xing

et al. 2004

Eye

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Purpose The optimal method and timing of the surgical treatment for idiopathic macular holes remains unknown. The aim of this retrospective study was to identify factors associated with anatomical and visual success in macular hole surgery. Methods Case records of 55 patients undergoing macular hole surgery at three units in the 2-year period up to July 2002 were reviewed to identify factors associated with anatomical and visual success. The following potential prognosticators were evaluated: patient age, hole stage, hole latency prior to surgery, preoperative acuity, simultaneous phacoemulsification, and intraocular lens implantation, internal limiting membrane peeling with and/or without indocyanine green, and postoperative posturing. Results The duration of preoperative symptoms, indocyanine green-assisted internal limiting membrane peeling, hole stage, and better preoperative visual acuity were associated with both anatomical success and regaining a postoperative visual acuity of 6/12 or better. Discussion The closure rate in patients undergoing surgery within 1 year of onset was 94.0%, and in those waiting 1 year or more it was 47.4%. Clinical governance and quality issues should dictate that NHS macular hole surgery is available to all within 1 year of onset. This study showed no adverse effect of ICG dye retinal staining. The results support the use of a 'patientfriendly' approach of simultaneous cataract surgery with no prone postoperative posturing.

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“…ICG definitely assists in visualisation of the ILM and enhances the ease of the operation as found in previous studies. 11 An incidental finding was that peeling of the ILM whether with ICG or without had a statistically significant improvement in final visual acuity for patients. …”

Section: Discussionmentioning

confidence: 99%

Macular hole surgery with and without indocyanine green assistance

Slaughter

Lee

2004

Eye

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Purpose To compare the results of macular hole surgery with the use of indocyanine green (ICG) to assist internal limiting membrane (ILM) peeling and macular hole surgery without indocyanine green use. Methods A retrospective, comparative, consecutive study of 68 patients with macular holes. In total, 34 patients underwent vitrectomy and ILM peeling, and 34 patients underwent vitrectomy and ILM peeling with the assistance of indocyanine green. The main outcome measures were postoperative visual acuity and macular hole status. Results Indocyanine green increased the ability to visualise and peel the ILM. The average preoperative visual acuity in the group where ICG was used was 6/36 and the group where ICG was not used was 6/60. The average follow-up was 25 weeks for the ICG group and 53 weeks for the group with no ICG. Both groups were also compared at 25 weeks follow-up. Hole closure rate for the group with ICG was 97% compared to 91% without ICG. The mean postoperative visual acuity was 6/24 for the group with ICG and 6/12 for the group without ICG, a difference of two lines on the Snellen chart when compared with the preoperative acuity (P-value 0.299, Student's t-test). Both groups had a mean improvement of Snellen acuity of two lines (ICG group: P-value 0.0002, Student's t-test; no ICG group: P-value 0.00004, Student's t-test). In all, 83% of patients in the ICG group maintained or improved their visual acuity compared to 91% in the group without ICG. Discussion There is no doubt that indocyanine green stains and assists in visualisation and therefore increases the ease of peeling the ILM in macular hole surgery. Initially, there was concern regarding a poorer outcome for patients with the use of ICG, which has also been previously discussed in the literature. When the two groups were compared at a similar follow-up time of approximately 25 weeks, it was shown that there was no statistically significant difference between the outcomes in the two groups. This study had an improved hole closure rate for the group where ICG was used, although it was not statistically significant.

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Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair

Cited by 275 publications

References 28 publications

Outcome of ICG-assisted ILM peel in macular hole surgery

Outcome of ICG-assisted ILM peel in macular hole surgery

Outcomes of macular hole surgery: implications for surgical management and clinical governance

Macular hole surgery with and without indocyanine green assistance

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