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Retinal ICG Accumulation after ILM Staining for Macular-foraminal Surgery?
Jesse I., Lommatzsch A., Pauleikhoff D.,
St. Franziskus-Hospital, Augenabteilung (Münster)
Purpose: In earlier animal studies a retinal accumulation of ICG after intravitreal application with following transport to the optic nerve could be observed. In order to evaluate the possible retinal accumulation of ICG after ILM staining during macular hole surgery and to examine the potential changes in optic nerve function a prospective study was initiated.
Patients and methods: In 10 patients with macular holes grade 3 a vitrectomy with ICG staining of the ILM (0,3 ml of a 1:10 diluted ICG solution under air) , consecutive ILM peeling and final gas tamponade was performed. All patients had preoperative, 2 weeks, 4 weeks, 8 weeks and 12 weeks after vitrectomy beside a normal ophthalmological examination a native ICG-picture, VEP examinations and a central visual field examination.
Results: In all 10 patients the macular hole was closed after the vitrectomy. But also in all patients a retinal ICG accumulation in the area of the macular hole, in the retinal axons at the temporal arcades and around the optic disc could be observed. This staining with ICG was progressively transformed towards the optic disc at the 4 and 8 week examination. At the 12 week examination still in all patients an ICG staining around the optic disc was visible. The function of the optic nerve (VEP) demonstrated only minor changes during follow up and in the visual field examinations only unspecific peripheral changes could be observed.
Conclusions: After ILM-staining with ICG during macular hole surgery even with highly diluted ICG solutions an accumulation of ICH in the retinal ganglion axons was observed. This accumulation was visible shortly after surgery at the macular hole, temporal arcades and the optic disc. The predominantly staining of ICG during follow up at the optic disc can be interpreted as transport of the accumulated ICG in the retinal axons and optic nerve. The functional implications for optic nerve function and visual field examinations appear very limited.