Article

Cytotoxicity of indocyanine green on retinal pigment epithelium: implications for macular hole surgery.

Department of Ophthalmology, Chang Gung Memorial Hospital, Kuei-Shan, Taoyuan, Taiwan.
Archives of Ophthalmology (impact factor: 3.71). 11/2003; 121(10):1423-9. DOI:10.1001/archopht.121.10.1423 pp.1423-9
Source: PubMed

ABSTRACT To evaluate the potential cytotoxic effects of indocyanine green (ICG) on cultured human retinal pigment epithelium (RPE) and the resultant implications for macular hole surgery.
Human RPE cells were exposed to ICG in concentrations from 0.001 to 5 mg/mL. The exposure duration ranged from 5 minutes to 3 hours. Light microscopy, MTS viability assay, and calcein AM-ethidium homodimer 1 staining were used to evaluate the cytotoxic effects of ICG.
The RPE cells incubated with up to 5 mg/mL of ICG for 5 minutes or less exhibited no morphologic change and no significant decrease in dehydrogenase activity. When RPE cells were exposed to 5 mg/mL of ICG for 10 minutes, 1 mg/mL of ICG for 20 minutes, or 0.01 mg/mL of ICG for 3 hours, cell morphologic features were altered, mitochondrial dehydrogenase activity decreased, and some cells were necrotic.
Indocyanine green caused cytotoxicity in cultured human RPE in a dose- and time-dependent manner. Cell death occurred by necrosis.
Exposure of RPE cells to ICG concentrations up to 5 mg/mL for 5 minutes or less was not injurious; prolonged exposure to a low ICG concentration was toxic. Since ICG may be retained in the vitreous cavity for a lengthy period, thorough washout of ICG during macular hole surgery is required.

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    Article: Visual acuity after vitrectomy and epiretinal membrane peeling with or without premacular indocyanine green injection.
    A Koestinger, E H Bovey
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    ABSTRACT: To compare postoperative visual acuity of eyes operated for an epiretinal membrane (ERM), with or without intraoperative intraocular indocyanine green (ICG) injection. Retrospective study of 75 pseudophakic eyes with epiretinal membrane operated by vitrectomy-peeling. In 20 cases operated in 2001 and 2002 (Group 1), ICG diluted in 5% glucose solution was injected intraoperatively into the vitreous. In another group of 55 cases operated between 1996 and 1999 (Group 2), ICG was not used. The mean visual acuity was 0.32(+1) and 0.32(+2) preoperatively, 0.4(+2) and 0.5 at 1 month, and 0.63 and 0.63(+2) on the final examination in Groups 1 and 2, respectively. Visual acuities were not significantly different between the two groups. Premacular injection of ICG during vitrectomy to facilitate epiretinal membrane peeling did not appear to compromise postoperative improvement of visual acuity. However, its use is questioned since it did not yield better postoperative results and because potential toxic adverse reactions could not be excluded by this study.
    European journal of ophthalmology 15(6):795-9. · 0.96 Impact Factor
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    Article: Long-term visual outcome after pars plana vitrectomy and ILM-Peeling with or without Indocyanine green
    C. Milojcic, B.V. Stanzel, N. Eter
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    ABSTRACT: PURPOSE: The intraoperative use of intravitreal indocyanine green (ICG) to dye the internal limiting membrane (ILM) to assist its peeling remains an ongoing debate. The purpose of this study was to investigate long-term visual outcomes in patients who underwent ILM-peeling with or without the use of ICG. METHODS: 301 eyes of 294 consecutive, nonrandomized patients with a follow-up period of at least 6 months were included into a retrospective study. 135 eyes suffered from idiopathic macular hole, 166 eyes had a macular pucker. In the macular hole-group ICG was used to stain the ILM of 117 eyes, while the macular pucker-group contained 111 eyes. 18 eyes with macular hole and 55 eyes with macular pucker underwent the identical procedure without the use of ICG. Follow-up examinations included testing for best corrected visual acuity (BCVA) and indirect ophthalmoscopy. RESULTS: Postoperative change in visual acuity (VA) was recorded 6 month after surgery in all patients. Mean last follow-up was 1.74 years after surgery (range 0.5–7 years). In macular hole-surgery with ICG median visual acuity increased from 0.13 (logMar 0.9) preoperatively to 0.25 (logMar 0.6) postoperatively after an average of 1.74 years. In the macular hole group operated without ICG median visual acuity remained unchanged at 0.2 (logMar 0.7). Also in the macular pucker group median visual acuity improved in the group with ICG from 0.3 (logMar 0.5) pre- to 0.4 (logMar 0.4) postoperatively after 1.74 years in average; in the group without ICG median visual acuity also remained stable at 0.4 (logMar 0.4) pre- as well as postoperatively at all quoted times. There was no statistically significant difference in visual outcome between procedures with or without ICG staining (p = 0.27). CONCLUSION: This study suggests a trend towards better visual outcomes with ICG-assisted ILM peeling. This may imply, if handled appropriately, potential ICG toxicity be negligible over same or better visual outcomes for the patient. ZIELSETZUNG: Der intraoperative Indocyanin grün (ICG)-Gebrauch zur Anfärbung der Membrana limitans interna (ILM) beim Membranpeeling wird bislang kontrovers diskutiert. Ziel dieser retrospektiven Langzeit-Studie war es, einen Unterschied im postoperativen Visusverlauf bei ILM peeling mit oder ohne ICG zu untersuchen. PATIENTEN UND METHODEN: 301 Augen von 294 konsekutiven Patienten mit einem postoperativen Beobachtungszeitraum von mindestens 6 Monaten wurden in der Langzeitstudie erfasst. 135 Augen wurden aufgrund eines Makulaforamens vitrektomiert, 166 bei epiretinalen Gliose. Innerhalb der Makulaforamen Gruppe wurde bei 117 Augen die ILM mit ICG angefärbt, in der epiretinalen Gliose-Gruppe jeweils 111 Augen. Hauptzielparameter war der bestkorrigierte Fernvisus, als Nebenzielkriterium galt der anatomische Befund mittels indirekter Ophthalmoskopie. ERGEBNISSE: Die postoperative Visusentwicklung wurde standardisiert nach 6 Monaten, sowie bei der letzten Kontrolle nach 1,74 Jahren (Median) getestet. Innerhalb der Makulaforamen-Gruppe mit ICG stieg der mediane Visus von präoperativ 0,13 (logMar 0,9) auf 0,25 (logMar 0,6) postoperativ an. Bei Patienten ohne ICG stagnierte der Median des Visus bei 0,2 (logMar 0,7). In der Gruppe mit epiretinaler Gliose und ICG stieg der Visus im Median von 0,3 (logMar 0,52) auf 0.4 (logMar 0,4) postoperativ an; in der Gruppe der epiretinalen Gliosen ohne ICG stagnierte der Visus bei 0,4 (logMar 0,4). Es gab keinen statistisch signifikanten Unterschied hinsichtlich der Visusentwicklung in Abhängigkeit vom ICG-Gebrauch (p = 0,27). SCHLUSSFOLGERUNG: Die vorliegende Studie zeigt beim ICG unterstützten ILM peeling einen Trend zu besseren postoperativen Langzeit Visusresultaten. Dies könnte bedeuten, dass bei richtiger Handhabung die potentielle ICG Toxizität gegenüber gleicher oder besserer Sehschärfe vernachlässigbar ist. KeywordsILM peeling-Vitrectomy-Staining-Indocyanine green SchlüsselwörterILM Peeling-Vitrektomie-Färben-Indocyanin grün
    Spektrum der Augenheilkunde 04/2012; 23(6):408-413. · 0.26 Impact Factor
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Keywords

10 minutes
 
20 minutes
 
5 minutes
 
cell morphologic features
 
cultured human retinal pigment epithelium
 
cultured human RPE
 
dehydrogenase activity
 
Human RPE cells
 
lengthy period
 
Light microscopy
 
low ICG concentration
 
macular hole surgery
 
mitochondrial dehydrogenase activity
 
MTS viability assay
 
potential cytotoxic effects
 
RPE cells
 
RPE cells incubated
 
significant decrease
 
thorough washout
 
vitreous cavity