This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kwok, A K H Articles by Woo, D C F Search for Related Content PubMed PubMed Citation Articles by Kwok, A K H Articles by Woo, D C F

Indocyanine green assisted retinal internal limiting membrane removal in stage 3 or 4 macular hole surgery

¹ Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital
² Prince of Wales Hospital, Hong Kong, People’s Republic of China
³ Department of Ophthalmology, Queen Mary Hospital, Hong Kong, People’s Republic of China
⁴ Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong, People’s Republic of China

Correspondence to:
Correspondence to:
Dr Alvin K H Kwok, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, 3/F, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong;
kwokak{at}netvigator.com

Aims: To determine surgical outcome in primary idiopathic stage 3 or 4 macular holes with indocyanine green (ICG) assisted retinal internal limiting membrane (ILM) peeling.

Methods: A prospective, consecutive, interventional case series with 41 eyes of 40 patients was included. No patient defaulted follow up. Besides a standard macular hole surgery, all eyes received ICG assisted ILM removal of 3–4 disc diameters around macular holes. At the end of the surgery, 12% perfluoropropane gas was used. A face down posture for 2 weeks was required postoperatively.

Results: The mean follow up period was 15.1 months (range 6–24 months). Twenty (48.8%) eyes had stage 3 macular holes and 21 (51.2%) had stage 4 macular holes. The overall median duration of holes was 11 months. 19 (46.3%) were chronic macular holes of more than 12 months’ duration. The anatomical success rates after one surgery was 87.8% (36 eyes), while that of chronic and non-chronic ones was 78.9% and 95.5%, respectively. The median preoperative and postoperative visual acuity was 20/200 (range 20/60 to counting fingers) and 20/100 (range 20/20 to 20/400), respectively. 24 (58.5%) eyes had improvement of two or more Snellen lines. The mean was 3.2 lines (range two to nine lines), with 3.6 lines and 2.7 lines for non-chronic and chronic holes, respectively. For all the 41 eyes, 16 (39%) eyes had a final visual acuity of 20/50 or better.

Conclusion: ICG assisted retinal ILM removal, in idiopathic primary chronic and non-chronic stage 3 or 4 macular hole surgery, appears to give a promising anatomical closure rate without compromising the visual result.

Keywords: indocyanine green; internal limiting membrane; macular hole

This article has been cited by other articles:

				E. Engel, R. Schraml, T. Maisch, K. Kobuch, B. Konig, R.-M. Szeimies, J. Hillenkamp, W. Baumler, and R. Vasold Light-Induced Decomposition of Indocyanine Green Invest. Ophthalmol. Vis. Sci., May 1, 2008; 49(5): 1777 - 1783. [Abstract] [Full Text] [PDF]

				J. Beutel, G. Dahmen, A. Ziegler, and H. Hoerauf Internal Limiting Membrane Peeling With Indocyanine Green or Trypan Blue in Macular Hole Surgery: A Randomized Trial Arch Ophthalmol, March 1, 2007; 125(3): 326 - 332. [Abstract] [Full Text] [PDF]

				P. Saikia, T. Maisch, K. Kobuch, T. L. Jackson, W. Baumler, R.-M. Szeimies, V.-P. Gabel, and J. Hillenkamp Safety Testing of Indocyanine Green in an Ex Vivo Porcine Retina Model Invest. Ophthalmol. Vis. Sci., November 1, 2006; 47(11): 4998 - 5003. [Abstract] [Full Text] [PDF]

				H K F Yip, T Y Y Lai, K-F So, and A K H Kwok Retinal ganglion cells toxicity caused by photosensitising effects of intravitreal indocyanine green with illumination in rat eyes Br. J. Ophthalmol., January 1, 2006; 90(1): 99 - 102. [Abstract] [Full Text] [PDF]

				A K H Kwok, T Y Y Lai, and W W K Yip Vitrectomy and gas tamponade without internal limiting membrane peeling for myopic foveoschisis Br. J. Ophthalmol., September 1, 2005; 89(9): 1180 - 1183. [Abstract] [Full Text] [PDF]

				A K H Kwok, T Y Y Lai, C-K Yeung, Y-S Yeung, W W Y Li, and S W Chiang The effects of indocyanine green and endoillumination on rabbit retina: an electroretinographic and histological study Br. J. Ophthalmol., July 1, 2005; 89(7): 897 - 900. [Abstract] [Full Text] [PDF]

				K L Lee, S Dean, and S Guest A comparison of outcomes after indocyanine green and trypan blue assisted internal limiting membrane peeling during macular hole surgery Br. J. Ophthalmol., April 1, 2005; 89(4): 420 - 424. [Abstract] [Full Text] [PDF]

				J Hillenkamp, P Saikia, F Gora, H G Sachs, C P Lohmann, J Roider, W Baumler, and V-P Gabel Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green Br. J. Ophthalmol., April 1, 2005; 89(4): 437 - 443. [Abstract] [Full Text] [PDF]

				R. Narayanan, M. C. Kenney, S. Kamjoo, T.-H. T. Trinh, G. M. Seigel, G. P. Resende, and B. D. Kuppermann Trypan Blue: Effect on Retinal Pigment Epithelial and Neurosensory Retinal Cells Invest. Ophthalmol. Vis. Sci., January 1, 2005; 46(1): 304 - 309. [Abstract] [Full Text] [PDF]

				D Thomas, C Bunce, C Moorman, and D A H Laidlaw A randomised controlled feasibility trial of vitrectomy versus laser for diabetic macular oedema Br. J. Ophthalmol., January 1, 2005; 89(1): 81 - 86. [Abstract] [Full Text] [PDF]

				T. L. Jackson, B. Vote, B. C. Knight, A. El-Amir, M. R. Stanford, and J. Marshall Safety Testing of Infracyanine Green Using Retinal Pigment Epithelium and Glial Cell Cultures Invest. Ophthalmol. Vis. Sci., October 1, 2004; 45(10): 3697 - 3703. [Abstract] [Full Text] [PDF]

				T. L. Jackson, J. Hillenkamp, B. C. Knight, J.-J. Zhang, D. Thomas, M. R. Stanford, and J. Marshall Safety Testing of Indocyanine Green and Trypan Blue Using Retinal Pigment Epithelium and Glial Cell Cultures Invest. Ophthalmol. Vis. Sci., August 1, 2004; 45(8): 2778 - 2785. [Abstract] [Full Text] [PDF]

				N. Horio and M. Horiguchi Effect on Visual Outcome After Macular Hole Surgery When Staining the Internal Limiting Membrane With Indocyanine Green Dye Arch Ophthalmol, July 1, 2004; 122(7): 992 - 996. [Abstract] [Full Text] [PDF]

				J-D Ho, R J-F Tsai, S-N Chen, and H-C Chen Removal of sodium from the solvent reduces retinal pigment epithelium toxicity caused by indocyanine green: implications for macular hole surgery Br. J. Ophthalmol., April 1, 2004; 88(4): 556 - 559. [Abstract] [Full Text] [PDF]

				A. Iriyama, S. Uchida, Y. Yanagi, Y. Tamaki, Y. Inoue, K. Matsuura, K. Kadonosono, and M. Araie Effects of Indocyanine Green on Retinal Ganglion Cells Invest. Ophthalmol. Vis. Sci., March 1, 2004; 45(3): 943 - 947. [Abstract] [Full Text] [PDF]

				S. Grisanti, P. Szurman, F. Gelisken, S. Aisenbrey, J. Oficjalska-Mlynczak, and K. U. Bartz-Schmidt Histological Findings in Experimental Macular Surgery with Indocyanine Green Invest. Ophthalmol. Vis. Sci., January 1, 2004; 45(1): 282 - 286. [Abstract] [Full Text] [PDF]

				A K H Kwok and T Y Y Lai Internal limiting membrane removal in macular hole surgery for severely myopic eyes: a case-control study Br. J. Ophthalmol., July 1, 2003; 87(7): 885 - 889. [Abstract] [Full Text] [PDF]