Indocyanine green staining and removal of internal limiting membrane in macular hole surgery: histology and outcome

Kwok, Alex Pak Ki; Li, Winnie W. Y.; Pang, Chi Pui; Lai, Timothy Y. Y.; Yam, Gary Hin Fai; Chan, Nongnart R.; Lam, Dennis S.C.

doi:10.1016/s0002-9394(01)00976-x

Cited by 176 publications

(113 citation statements)

References 24 publications

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“…[2][3][4][5][6] However, recent studies have suggested less favourable functional results, and histopathologic analysis of operative 9 and cell culture 10,11 specimens has suggested that ICG may be toxic to the retina. Our observations during this study support these findings.…”

Section: Discussionmentioning

confidence: 99%

“…1 It is a technically demanding procedure, and many surgeons prefer to stain the membrane with indocyanine green (ICG) to provide contrast and facilitate peeling, resulting in high anatomical success rates. [2][3][4][5][6] Recent clinical 7,8 and histopathological [9][10][11] studies have suggested that ICG may be toxic to the retina. We assessed anatomical and functional results of ICG-assisted ILM peel for macular hole and attempted to identify potential factors that may affect the outcome of the procedure through a search of the literature.…”

Section: Introductionmentioning

confidence: 99%

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Visual outcomes following ICG assisted ILM peel for Macular Hole

Posselt

Rahman

Smith

et al. 2004

Eye

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Purpose To evaluate the anatomical and visual outcome of indocyanine green (ICG)-assisted internal limiting membrane (ILM) peeling for macular hole surgery. A literature search identified potential factors that may affect the functional success of the procedure. Methods Retrospective case note review of 14 consecutive patients undergoing phacovitrectomy, gas and ICG-assisted ILM peeling for macular hole from July 2001 to July 2002. A 0.5% ICG solution (osmolarity 270 mOsm) was left in contact with the retina for 1-3 min. The outcome measures were hole closure, change in visual acuity, and macular pigmentary changes. Results Anatomical hole closure was achieved in 13 of 14 eyes (92.8%). The mean logMAR Snellen acuities were 0.80 (range 0.60-1.30) preoperatively and 0.77 (0.48-1.30) postoperatively. Seven eyes (50%) developed retinal pigmentary changes in the macular area Conclusions ICG-assisted ILM peeling for macular hole surgery achieves high rates of anatomical hole closure, but functional results are less encouraging. Previous studies suggest toxicity of the ICG to the retina, at the level of the RPE or inner retina. The results may be optimized by using a lower concentration, isoosmolar, viscous solution, and by minimizing contact time of the solution and intensity, and duration of illumination.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Visual outcomes following ICG assisted ILM peel for Macular Hole

Posselt

Rahman

Smith

et al. 2004

Eye

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“…18 Another commonly used ophthalmic dye, indocyanine green (ICG), has been shown to stain and facilitate the removal of ILM around macular holes with good anatomical and visual outcomes. [19][20][21][22][23] It has also been used in surgery for proliferative vitreoretinopathy and retinal detachment to facilitate ERM and ILM removal. [24][25][26] In order to improve the visualisation of both the ERM and ILM, the use of a double-staining technique using Tb followed by ICG may facilitate ERM and ILM removal in macular pucker surgery.…”

Section: Introductionmentioning

confidence: 99%

Trypan blue- and indocyanine green-assisted epiretinal membrane surgery: clinical and histopathological studies

Kwok

Lai

et al. 2004

Eye

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Purpose To evaluate the clinical outcome and electron microscopic findings of trypan blue (Tb) and indocyanine green (ICG) assisted epiretinal membrane (ERM) surgery. Methods This is a prospective consecutive noncomparative interventional case series. After pars plana vitrectomy, 0.1 ml of 0.6 mg/ml Tb solution was applied for 1 min under air for ERM staining. After ERM removal, internal limiting membrane (ILM) was further peeled after staining with 0.2 ml of 1 mg/ml ICG solution. Intraoperative specimens were sent for electron microscopy. Tb was considered useful if the edge of ERM was stained where peeling could be initiated with a clearer visualisation of the overall extent of the ERM. Results In all, 16 eyes from 16 patients were recruited. There were nine grade 1 ERMs, five grade 2 ERMs, and two grade 3 ERMs. Tb was useful in six (67%) of the nine eyes with grade 1 ERMs and in all eyes with grade 2 or 3 ERMs. The three remaining grade 1 ERMs were removed together with surrounding ILM that was stained by ICG. The mean line of improvement was 1.3 lines with the median BCVA improved from 6/12 to 6/9. All 16 eyes had symptomatic improvement and none developed ERM recurrence. No complication related to Tb or ICG was observed clinically or angiographically. Electron microscopy of the Tb-stained ERM specimens showed fragments of ILM in all specimens. Conclusions Tb and ICG are useful intraoperatively to improve the visualisation and facilitate complete removal of ERM and ILM in macular ERM surgery.

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“…Clinicamente, as cirurgias que fizeram uso de ICG apresentaram atrofia óptica e de epitélio pigmentário da retina (EPR) bem como defeitos de campo visual (1) . Análises histopatológicas disponíveis na literatura de MLI retirada durante a cromovitrectomia com ICG mostrou resultados controversos de toxicidade nos tecidos subjacentes à membrana limitante interna removida (11) . A presença de constituintes retinianos como membranas plasmá-ticas de células de Müller, miofibroblastos e astrócitos aderidos à face retiniana da MLI após ser corada com ICG gerou um conceito de risco aumentado para lesões retinianas.…”

Section: Indocianina Verde (Icg)unclassified