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Impressum
Intravitreal indocyanine green-application in macular hole surgery
Weinberger A. W. A., Hermel M., Mazinani B. A. E., Kirchhof B., Schrage N. F.
Augenklinik, RWTH Aachen
Purpose: Poor visualization of epiretinal membranes during pars
plana vitrectomy is an obstacle for successful surgery in macular holes
or epiretinal gliosis. Recently, several centers have reported the visualization
of these membranes with intraocular application of diluted ICG. In this
study we report functional and histological results of a patient series.
Methods: Eighteen patients with macular holes stage II-IV were
included. Membrane peeling was performd using a standard 3-port vitrectomy,
application of three drops of 1:9 diluted ICG onto the posterior pole,
and homologous thrombocyte concentrate application to the macular hole
as well as gas endotamponade. Before and at 6 weeks after surgery visual
acuity, fundus photographs, fundus autofluorescence and humphrey 24-2
visual fields were obtained. The extracted membranes were histologically
analysed.
Results: Intraoperatively the internal limiting membrane could
be visualized with ICG. Visual acuity improved in 14 eyes, remained stable
in 2 eyes and decreased in 4 eyes. These 4 eyes had reduction of visual
acuity due to cataract (2), nummuli and corneal epithelial disturbance.
Funduscopy revealed a macular hole closure in all eyes. Autofluorescence
imaging at 790 nm showed a persistent signal in all patients, central
visual fields showed no significant alterations postoperatively. Histologic
analysis of the membranes revealed no content of Müller cells.
Conclusion: ICG as an intraoperative tool for visualization of
epiretinal membranes or ILM alleviates surgical procedures. We did not
observe any toxic effect to the retinal function by ICG, however, we were
surprised by the visualization of traces of ICG on autofluorescence images
6 weeks postoperatively. In order to rule out negative long term effects
of persistent ICG, we will follow these patients until ICG-autofluorescence
fades out.