Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green

Abstract

Aim: To investigate macular function and morphology after surgical removal of idiopathic epiretinal membrane (IEM) with and without assistance of indocyanine green (ICG). Methods: A retrospective study as a consecutive case series, of 39 patients with IEM. 39 patients, 23 female, 16 male, mean age 67 years, underwent standard three port pars plana vitrectomy with removal of epiretinal membrane. Two groups of patients were consecutively operated: in 20 patients ICG 0.1% in glucose 5% was used to stain the epiretinal membrane. 19 patients underwent the identical procedure but without use of ICG. Postoperative follow up was 1-92 months (mean 15.5 months). Functional outcome was assessed with subjective improvement, best corrected visual acuity (BCVA), Amsler grid test, 10˚and 30˚automated perimetry (Heidelberg visual field analyser) (HFA), and Goldmann kinetic perimetry. Macular morphology was assessed with stereoscopic biomicroscopy and optical coherence tomography (OCT). The main outcome measures were macular function as determined by BCVA, presence of visual field defects, and metamorphopsia as determined by Amsler grid test, macular morphology as determined by slit lamp biomicroscopy, and OCT. Results: BCVA improved in 28 patients, remained unchanged in eight patients, and decreased in three patients. Improvement of BCVA was statistically significant in both groups (p = 0.003). Mean BCVA in patients operated with ICG improved from 0.33 preoperatively to 0.53 postoperatively. Mean BCVA in patients operated without ICG improved from 0.32 preoperatively to 0.54 postoperatively. Reduction of macular oedema as measured by OCT was statistically significant in both groups (p,0.01). There was no statistically significant difference in postoperative BCVA, macular oedema as measured by OCT, postoperative Amsler grid test, and subjective improvement between the two groups. The incidence of residual or recurrent epiretinal membrane was greater in the group operated without ICG (p = 0.014). Visual field defects were detected in one patient operated with ICG and in three patients operated without ICG. Conclusions: Removal of epiretinal tissue with or without assistance of ICG improved visual function and reduced macular oedema in most patients. Adverse effects clearly attributable to the use of ICG were not observed but further investigation is warranted.

Assessment of macular function by multifocal electroretinography following epiretinal membrane surgery with indocyanine green-assisted internal limiting membrane peeling

“…In a study by Hillenkamp et al, 1 mg/ml ICG dissolved in glucose 5% was applied in fluid-filled globe for ERM staining and no clinically detectable adverse effects were observed postoperatively [3]. The lack of adverse effects might be related to the solvent used, as it has been suggested that ICG retinal toxicity may be related to hypoosmotic solvent [21].…”

“…Since the ILM is a friable transparent membrane, its removal can be technically difficult due to poor visualization, and indocyanine green (ICG) staining has been used to facilitate removal during ERM surgery [1,3,[10][11][12]20]. However, adverse outcome has been reported postoperatively, and laboratory studies have also demonstrated ICG-related retinal toxicity [1, 6-9, 13, 23, 24].…”

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

“…This might be expected to reduce the volume and concentration of dye reaching inner retinal elements, and some studies suggest that ICG is cleared more quickly from the eye in this setting. 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.…”

Comparison of macular function and visual fields after membrane blue or infracyanine green staining in vitreoretinal surgery

“…Blue-stained ILM had less retinal debris, while the lowest level retinal fragments were found in unstained ILM [26]. However, the incidence of residual or recurrent ERM was proven to be greater in eyes operated without staining [27,28]. This finding may be related to a greater number of incomplete removals of ERM.…”