Indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for macular hole repair

Objective: To determine the efficacy and safety of indocyanine green (ICG)- assisted retinal internal limiting membrane (ILM) peeling during macular ho le repair. Designs interventional, noncomparative, prospective case series. Participants: Twenty-four consecutive patients (24 eyes) with stage 3 or 4 macular holes. Intervention: All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0 .5%) was instilled into the posterior vitreous cavity over the macula and l eft in place for 3 to 5 minutes. 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 face down for 1 to 2 weeks. Main Outcome Measures: Intraoperative staining properties of ICG, technical ease of peeling of the retinal ILM, postoperative anatomic results, visual acuity, and complications were recorded. Results: Indocyanine green stained the retinal ILM, but did not stain the u nderlying retina. Indocyanine green staining greatly facilitated the surgeo ns' ability to visualize and peel the ILM in each case. Peeled tissue was s ent for both light and electron microscopic studies, which confirmed that t he ICG-stained tissue was truly retinal ILM. Patients were observed after s urgery for an average of 123 days (range, 23-195 days). Anatomic closure of the macular hole was achieved in 21 eyes (88%) with a single surgery. Visu al acuity improved in 23 of 24 patients (96%) after surgery. There were no intra- or postoperative complications related to ICG use, and there was no clinical or fluorescein angiographic evidence of ICG toxicity. Conclusions: Indocyanine green stains the retinal ILM. This property facili tates ILM peeling by providing a stark contrast between the stained ILM and the unstained retina. Indocyanine green staining of the ILM appears to be a safe and useful adjunct in vitreous surgery for macular hole repair. Opht halmology 2001;108:1187-1192 (C) 2001 by the American Academy of Ophthalmol ogy.