Removal of sodium from the solvent reduces retinal pigment epithelium toxicity caused by indocyanine green: implications for macular hole surgery

Ho, Jau Der; Tsai, Jui-Fang; Chen, S. N.; Chen, H. C.

doi:10.1136/bjo.2003.018523

Cited by 43 publications

(27 citation statements)

References 22 publications

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“…sodium iodate, has been proposed to gain access to the RPE cell layer by two mechanisms: flow through the idiopathic MH or crossing through all retinal layers. Several investigations in vivo in various animal models have suggested ICG to be hazardous to the RPE in a dose-dependent manner [50,51,52,53]. Recently, Czajka et al [52] simulated human MH surgery to test the effects of ICG on the retina in a novel porcine model.…”

Section: Discussionmentioning

confidence: 99%

“…Sippy et al [53] reported that a short exposure of in vitro cultured human RPE cells to 0.1% ICG solution resulted in decreased mitochondrial enzyme activity, but did not influence the cellular morphology itself. Recently, Ho et al[ 50, 51] have postulated that removal of Na + from the solvent reduces ICG-induced RPE toxicity. Further in vivo studies are necessary to confirm the exact mechanism by which ICG induces RPE damage.…”

Section: Discussionmentioning

confidence: 99%

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Meta-Analysis of Chromovitrectomy with Indocyanine Green in Macular Hole Surgery

Rodrigues

Meyer

2008

Ophthalmologica

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Purpose: To report a meta-analysis of the literature comparing internal limiting membrane (ILM) peeling with and without indocyanine green (ICG) staining in macular hole (MH) treatment. Methods: A Pubmed search was conducted from January 1999 to June 2004. Manuscripts describing the anatomical and functional outcomes of vitrectomy plus ILM peeling with and without ICG application in MH surgery were reviewed. A statistical meta-analysis was performed including studies which defined anatomical outcomes as closure of the MH and disappearance of the fluid cuff and functional outcomes as improvement of 2 or more Snellen lines. A secondary outcome was to investigate the incidence of retinal pigment epithelium (RPE) alterations with and without ICG staining in MH surgery. Results: Results including all types of MHs in 837 eyes indicated the same anatomical success but worse functional outcomes in the group with ICG application (p = 0.0008; odds ratio = 0.587, 95% confidence interval = 0.427–0.808). A higher incidence of RPE alterations in the ICG injection group was observed. The incidence of RPE alterations was found to be 1.98%, whereas RPE changes were noted in 13.83% of 201 patients with ICG application (odds ratio = 7.998). Conclusion: This meta-analysis of previous reports comparing ILM peeling with and without intravitreal ICG application in the treatment of MHs demonstrated statistically worse functional outcomes when ICG was applied (p = 0.0008). A higher number of RPE alterations were observed in the ICG-stained group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Meta-Analysis of Chromovitrectomy with Indocyanine Green in Macular Hole Surgery

Rodrigues

Meyer

2008

Ophthalmologica

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“…Direct toxicity, upregulation of apoptosis-related genes, 19 hypoosmolarity of the solvent, 20 intraoperative retinal illumination, 21,22 and the role of sodium were hypothesized as possible factors that could increase retinal ICG toxicity. 23,24 There are several limitations in our study. Fluorogold has been used for decades as the standard dye for retrograde labeling of RGCs.…”

Section: Discussionmentioning

confidence: 94%

The structural effect of intravitreal Brilliant blue G and Indocyanine green in rats eyes

Ooi

Khang

Naidu

et al. 2012

Eye

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Purpose To compare the potential retinal toxicity of two commercially Brilliant blue G dyes (Brilliant Peel and Ocublue Plus) and Indocyanine green (ICG) at usual clinical concentration. Methods Brilliant Peel 0.025% (n ¼ 9), Ocublue Plus 0.025% (n ¼ 9), and ICG 0.05% (n ¼ 9) were injected intravitreally into Sprague-Dawley rat left eyes with balanced salt solution injected in the contralateral eyes as control. Evaluation of the effect of the dyes on retinal architecture was done by histological analysis of neurosensory retinal thickness and retinal ganglion cell (RGC) counts 7 days after intravitreal injection. Paired t-test was done to detect the presence of biologically significant thinning in neurosensory retina and five retinal layers for each dye (paired t-tests). One-way ANOVA and Tukey's Honestly Significant Difference test were used to assess whether different dyes caused significant thinning in mean neurosensory retinal thickness and reduction of mean RGC density. Results Eyes treated with ICG had significantly thinner mean total neurosensory retinal thickness compared with the control eyes (P-value ¼ 0.01), followed by those treated with Ocublue Plus (P-value ¼ 0.03). Brilliant Peel did not cause significant thinning in any of the five retinal layers (all P-values40.05). No significant difference in mean thinning of the total retinal thickness was detected between dyes (P-value ¼ 0.11). The mean thickness of the photoreceptor outer segment and outer plexiform layers were significantly reduced in ICG-injected eyes when compared with the control eyes (P-value ¼ 0.02). No significant difference in mean thinning between the three dyes was detected at all five retinal layers using one-way ANOVA (all P-values40.35). RGC density was significantly reduced for ICG (P-value ¼ 0.01) but only marginally for Ocublue Plus (P-value ¼ 0.05). No significant reduction in RGC density was observed for Brilliant Peel (P-value ¼ 0.2). Conclusion Intravitreal Brilliant Peel is safe to rats retina. The retinal thinning and reduction in RGC density induced by Ocublue Plus requires further studies to determine the safety profile of this product. Potential retinal toxicity is seen with ICG 0.05%.

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“…Several investigations in various animal models have suggested that ICG may be hazardous to the RPE [87,100,101,102,103,104,105]. Experiments in rats by Enaida et al [84] showed that moderate to high doses (2.5 or 25 mg/ml) of intravitreal ICG were toxic to retinochoroidal cells, and impaired retinal function was described even at low doses of ICG (0.025 mg/ml).…”

Section: Complicationsmentioning

confidence: 99%

“…(1) The dye should be diluted in nonsaline solution to avoid precipitation and to decrease the risk of Na-dependent toxicity [101]. …”

Section: Future Perspectives and Conclusionmentioning

confidence: 99%

Intravitreal Staining of the Internal Limiting Membrane Using Indocyanine Green in the Treatment of Macular Holes

Rodrigues¹,

Meyer²,

Farah³

et al. 2005

Ophthalmologica

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Surgical management of macular holes consists of pars plana vitrectomy, removal of the posterior hyaloid facia, and peeling of the epiretinal membranes (ERM). Additionally, removal of the internal limiting membrane (ILM) may enable an increase in the anatomic and functional success rates. However, recognition of fine ILM is difficult thus increasing the time that the macula is exposed to intraoperative light. Staining the ILM with indocyanine green (ICG) dye during vitrectomy facilitates recognition of the ILM and assures that all adjacent ERM are removed. Therefore, ICG-assisted ILM peeling has gained worldwide popularity among vitreoretinal surgeons. However, there are some concerns about the intravitreal ICG application. Reports in the literature described a variety of application techniques using different concentrations. The postoperative outcomes were controversial reporting heterogeneous anatomical and functional outcomes after ICG application, as well as descriptions of adverse effects related to the dye. We discuss the indications, techniques, surgical results, and complications after intravitreal ICG injection for the treatment of macular holes.

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Removal of sodium from the solvent reduces retinal pigment epithelium toxicity caused by indocyanine green: implications for macular hole surgery

Cited by 43 publications

References 22 publications

Meta-Analysis of Chromovitrectomy with Indocyanine Green in Macular Hole Surgery

Meta-Analysis of Chromovitrectomy with Indocyanine Green in Macular Hole Surgery

The structural effect of intravitreal Brilliant blue G and Indocyanine green in rats eyes

Intravitreal Staining of the Internal Limiting Membrane Using Indocyanine Green in the Treatment of Macular Holes

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