Indocyanine green-assisted peeling of the internal limiting membrane may cause retinal damage

PURPOSE: To demonstrate possible retinal damage caused by indocyanine green dye for staining of the internal limiting membrane in surgery for idiopath ic macular hole. METHODS: Consecutive interventional case series. We report on the ultrastru ctural findings of the internal limiting membrane in 10 eyes of 10 patients . RESULTS: All specimens revealed not only the internal limiting membrane, bu t also some small amounts of retinal elements, such as the plasma membrane of Muller cells and other undetermined structures. This indicates a cleavag e plane not exactly at the inner undulating aspect of the internal limiting membrane but within the inner, most retinal layers. CONCLUSION: Dilutions of indocyanine green as recommended in the literature may alter the structure of the retina to some degree. Possible factors res ponsible for this inadvertent action may include (1) concentration, (2) osm olarity pH, (3) time of tissue contact, and (4) mechanical factors from mor e forceful traction during peeling. Although functional consequences of the se findings remain unclear as yet, factors that may induce damage to the in nermost retina should be elucidated. (Am J Ophthalmol 2001;132:431-433. (C) 2001 by Elsevier Science Inc. All rights reserved.).