Internal Limiting Membrane Peeling With Indocyanine Green or Trypan Blue in Macular Hole Surgery

Beutel, Julia; G, Dahmen; Ziegler, Andreas; Hoerauf, Hans

doi:10.1001/archopht.125.3.326

Cited by 95 publications

(68 citation statements)

References 48 publications

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“…One found a significant increase in visual field defects 1 and neither found any effect on acuity. 61 A large non-randomized study found that ICG was associated with lower rates of anatomic success, and worse acuity in those eyes with closed holes.…”

Section: Summary Of Icg Clinical Studiesmentioning

confidence: 91%

“…39 It is also interesting that the randomised study of epiretinal membrane surgery by Hillenkamp et al 40 did not find visual field defects associated with ICG use, whereas a randomised study of macular hole surgery did. 1 The molecular weight of ICG is 775, and experimental studies show that molecules of this size pass rapidly across the retina. 41 Therefore, while an intact retina has the potential to reduce the level of dye exposure, it may not exclude it altogether.…”

Section: -38mentioning

confidence: 99%

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Vital staining with indocyanine green: a review of the clinical and experimental studies relating to safety

Stanescu-Segall

Jackson

2008

Eye

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Indocyanine green (ICG) is extremely effective when used as a vital stain during macular hole surgery. By staining the internal limiting membrane, ICG facilitates removal of this delicate and sometimes hard to visualize structure. There is, however, considerable debate regarding its safety. This review considers the clinical and experimental studies of ICG and a related agent, infracyanine green. Some clinical papers show visual field defects, reduced visual acuity, and persistence of ICG at the macula and optic nerve. Other clinical studies fail to demonstrate toxicity. The experimental studies are also conflicting, but there are emerging trends. These suggest that surgeons who continue to use ICG should use concentrations not greater than 0.05 mg/ml, in fluid-filled eyes, with short exposure times, iso-osmolar solutions, and avoid proximal or prolonged endoillumination of stained tissue. A smaller number of studies suggest that infracyanine green produces similar staining to ICG, and may possibly be safer, but there are too few well-designed studies to reach a conclusion. Although the use of ICG continues, on the balance of evidence, this review suggests that it is has the potential to produce subtle visual damage.

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Section: Summary Of Icg Clinical Studiesmentioning

confidence: 91%

Section: -38mentioning

confidence: 99%

Vital staining with indocyanine green: a review of the clinical and experimental studies relating to safety

Stanescu-Segall

Jackson

2008

Eye

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“…Two comparative studies showed same rate of closure stage II to IV idiopathic MH using ICG or TB. However, vision was significantly better only in the TB-group (44,45) . Although many clinical studies reveal that TB exerted little or no toxic effect to the retina, TB-staining may produce retinal damage, especially at higher concentrations (4,46,47) .…”

Section: Trypan Bluementioning

confidence: 84%

State of the art in chromovitrectomy

Caiado¹,

Moraes-Filho²,

Maia³

et al. 2014

Revista Brasileira De Oftalmologia

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Vitrectomy is a surgery that involves complex and delicate techniques that treat diseases such as macular hole, epiretinal membrane and diabetic macular edema. Chromovitrectomy is one of these techniques and includes the use of coloring agents such as vital dyes or crystals to enhanced visibility of transparent structures during vitrectomy. The aim of this study was to present a modern approach, based on scientific evidence, about the application and indication of vital coloring agents during vitrectomy. The use of such agents has made this surgery more predictable and has increased its post-operative prognosis. Although research on chromovitrectomy is currently expanding there is still not an established gold standard dyeing agent.Keywords: Vitrectomy; Vitreous body; Macular hole; Retina; Dyeing agents; Epiretinal membrane RESUMOA cirurgia vitreorretiniana é uma cirurgia que envolve técnicas complexas e delicadas que tratam doenças como buraco macular, membrana epirretiniana e o edema macular diabético. A cromovitrectomia é uma dessas técnicas que incluem o uso de corantes compostos de pigmentos vitais ou cristais para melhorar a visibilização de estruturas transparentes durante a cirurgia de vitrectomia. O objetivo desse artigo foi apresentar uma abordagem atual, baseada em evidências, sobre a aplicação e indicação de corantes vitais durante a cirurgia vitreorretiniana. O emprego desses corantes possibilitou uma maior previsibilidade para a cirurgia, melhorando assim seu prognóstico pós-operatório. Apesar do campo da cromovitrectomia está em plena expansão de pesquisas, um corante gold standard para cromovitrectomia ainda não está estabelecido.

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“…However, visual recovery was statistically significant only in the TB group and there was a higher rate of persistent central scotomata in the ICG group, suggesting that even low-dose ICG may have a potentially adverse effect on functional results. 75 …”

Section: Peeling Of the Ilmmentioning

confidence: 99%

Macular holes: vitreoretinal relationships and surgical approaches

Bainbridge

Herbert

Gregor

2008

Eye

100

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Idiopathic full-thickness macular holes develop as a result of anteroposterior and tangential traction exerted by the posterior vitreous cortex at the fovea. Vitreoretinal relationships during the development of macular holes can be demonstrated in detail by ocular coherence tomography, facilitating an improved understanding of their pathogenesis and guiding clinical management. Surgical strategies for the repair of macular holes are designed to relieve vitreofoveal traction and to promote flattening and reapposition of the macular hole edges by intraocular gas tamponade. A period of facedown positioning postoperatively is conventionally advised. However, the evidence to support this recommendation is weak and practice varies considerably. Surgical removal of the inner limiting membrane (ILM) is advocated to ensure thorough removal of any tangential tractional components including any residual cortical vitreous. Current evidence suggests that ILM peeling can improve anatomical outcomes but the effect on visual function is less predictable; unsuccessful attempts to peel the ILM can be associated with poor visual outcome. The use of vital dyes can facilitate visualisation of the ILM and help achieve complete, atraumatic peeling. Indocyanine green dye can enable high rates of macular hole closure but has been associated with poorer visual outcomes suggesting a dosedependent toxicity. Trypan blue dye offers an alternative that may have a more favourable risk profile. An improved understanding of vitreoretinal relationships may facilitate a tailored approach to surgery in individuals with macular holes. Vitrectomy to relieve anteroposterior traction is central in the management of all full-thickness holes. The use of long-acting gases, prolonged face-down positioning, and ILM peeling may be more valuable for larger holes, longstanding holes, and those that have failed to close following conventional surgery.

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Internal Limiting Membrane Peeling With Indocyanine Green or Trypan Blue in Macular Hole Surgery

Cited by 95 publications

References 48 publications

Vital staining with indocyanine green: a review of the clinical and experimental studies relating to safety

Vital staining with indocyanine green: a review of the clinical and experimental studies relating to safety

State of the art in chromovitrectomy

Macular holes: vitreoretinal relationships and surgical approaches

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