Long-term follow-up of indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for idiopathic macular hole repair

Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio, United States
Ophthalmology (Impact Factor: 6.14). 01/2005; 111(12):2246-53. DOI: 10.1016/j.ophtha.2004.05.037
Source: PubMed


To determine the long-term efficacy of indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling during macular hole repair.
Retrospective, interventional, noncomparative case series.
One hundred twenty-one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG-assisted macular hole repair during the period of August 1999 to January 2003.
All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long-acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks.
Long-term postoperative anatomic results, visual acuity (VA), and complications.
Patients were observed postoperatively for an average of 26 months (range, 12-53). Anatomic closure of the macular hole was achieved in 118 eyes (98%) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by > or =2 lines in 116 eyes (96%). Mean visual improvement after surgery was 6 lines (range, 0-14), and 96 eyes (79%) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG.
Long-term follow-up of patients who underwent ICG-assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.

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    • "The internal limiting membrane (ILM) of the retina is a periodic acid-Schiff-positive structure 1-2 μm in thickness derived from Muller glial cells. The ILM is intimately associated with Muller footplates and combines with vitreous collagen fibrils.1 Vitreoretinal surgery along with ILM peeling has been an effective therapeutic intervention for various maculopathies such as idiopathic macular hole (IMH),2 diffuse diabetic macular edema (DME),3 macular edema in central retinal vein occlusion (CRVO)4,5 and branch retinal vein occlusion (BRVO),5,6 as well as cases with persistent cystoid macular edema (CME) following cataract surgery or uveitis.7 It has been hypothesized that pathologic conditions of the ILM, such as thickening, vitreomacular traction and interstitial edema may contribute to the course and pathogenesis of various types of maculopathies.5,8,9 "
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    ABSTRACT: Purpose To report micro- and ultrastructural features of internal limiting membranes (ILMs) in various maculopathies and to evaluate the effects of indocyanine green (ICG) and triamcinolone acetonide (TA) on epiretinal proliferations associated with ILM and on retinal cleavage plane. Methods ILMs from various maculopathies were evaluated regarding presence or absence of membrane-associated cells, type of cells and ILM thickness based on routine histopathology, immunohistochemistry and transmission electron microscopy (TEM). Results Thirty ILM specimens were enrolled; 25 of which were evaluated by histopathology and immunohistochemistry and 5 by TEM. ICG only had been used in 17 specimens, TA in 4, and both agents in one specimen. The majority of specimens were immunoreactive for glial fibrillary acidic protein and neuron specific enolase. No significant difference in specimen cellularity and alteration of cleavage plane was noted between ICG-stained and non-ICG-stained ILMs or between TA-assisted and non-TA-assisted ones. Excluding central retinal vein occlusion (CRVO) cases, acellularity was not observed in any of ILMs from diabetic macular edema (DME), cystoid macular edema (CME), and traumatic macular hole (TMH) eyes. TEM disclosed ILM thickening and cellularity in DME as compared to CRVO. Conclusion Acellular membranes from CRVO maculopathy may be a sequel of acute retinal ischemia. Thickened diabetic ILMs with high cellularity may be related to chronic activation of Muller cells. No obvious influence of ICG or TA on epiretinal cellularity was detected and the dyes seem to have no significant effect on cleavage plane.
    Full-text · Article · Apr 2014 · Journal of Ophthalmic & Vision Research
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    • "Outpatient postoperative fluid-gas exchange [35, 36], laser photocoagulation of the RPE surrounding the MH [37], enlargement of the previous ILM peeling after staining with indocyanine green (ICG) [4], tamponade with longer acting gas or with silicone oil [5, 6, 8, 34, 38, 39, 40, 41, 42, 43, 44, 45, 46] and extending the postoperative face-down positioning period [47, 48] have been widely reported in the literature. "
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    ABSTRACT: To report the surgical outcomes of reoperation of unclosed macular holes after initial vitrectomy with internal limiting membrane peeling. Seven eyes of 7 patients were submitted to a second procedure in which five radial retinal incisions were made, as deep as the retinal pigment epithelium, beginning one hole diameter away from its borders and extending centripetally until the hole's margins, avoiding the papilomacular bundle. Gas tamponade was performed and face-down positioning was recommended. Anatomical closure was achieved in all cases with the second procedure. Functional success was achieved in every patient; there was no loss of best corrected visual acuity (BCVA) lines. Mean line score gain was 5.6 lines (range 1-9 lines), with a mean final BCVA of 0.42 (range 0.05-0.5). Perifoveal relaxing incisions in stage IV macular holes that remained unclosed after internal limiting membrane peeling vitrectomy seem to have a positive effect on MH closure rates. Larger case series and an extended follow-up period are necessary in order to assess the efficacy and safety profile of this so far promising technique.
    Full-text · Article · May 2012 · Case Reports in Ophthalmology
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    • "Indocyanine green (ICG) is commonly used to stain the internal limiting membrane (ILM) [1,2] during macular surgery for the treatment of idiopathic macular holes [3-5] and diffuse diabetic macular edema [6]. However, the safety of intravitreal use of ICG is not well established. "
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    ABSTRACT: Background Indocyanine green (ICG) dye is commonly used to stain the inner limiting membrane during macular surgery. There are reports documenting the toxicity of ICG on retinal pigment epithelial cells, with conflicting results in retinal ganglion cells. In the present study, we evaluated the effect of ICG on retinal ganglion cells in vitro. Cultured rat retinal ganglion cells (RGC-5) were exposed to different concentrations of ICG (0.25, 0.5, 1.0, 1.25, & 5 mg/ml) and at various time intervals (1, 5, 15, 30, & 60 minutes). Changes in structural morphology were identified using phase contrast bright field microscopy. Cell viability was quantified using the neutral red assay and cell death was characterized using Annexin-V staining. Findings Significant morphologic changes were observed at the 15 and 60 min intervals for all concentrations, where a reduction in cell size and loss of normal spindle shape was noted. A dose dependent decrease in cell viability was observed with increasing concentration of ICG as well as increasing exposure intervals. Compared to control, 48-74% reduction in neutral red uptake at all concentrations for exposures 5 min or greater (p < 0.001). Even at 1 min exposure, a dose dependent decline was observed in cell viability, with a 28-48% decline for doses above 1.25 mg/ml (p = 0.007). Staining with Annexin-V, demonstrated a similar dose and time dependent increase in number of cells exhibiting early apoptosis. A greater than two-fold increase in Annexin-V expression for all doses at exposures greater than 1 min was noted. Conclusion ICG dye exhibits toxicity to retinal ganglion cells at clinically relevant doses following 1 min exposure.
    Full-text · Article · Nov 2009 · BMC Research Notes
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