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ICG-assisted ILM Peeling Versus Platelet Concentrate in Macular-hole Surgery
Roider J., Walter A. F.,
Universität Regensburg, Klinik und Poliklinik für Augenheilkunde (Regensburg)
Purpose: There is a debate on the use of indocyanine green (ICG) in peeling inner limiting membrane in macular hole surgery. Purpose of this retrospective study was the determination of differences in the outcome after membrane peeling with autologe platelete concentrate and after membrane peeling with indocyanine green (ICG).
Method: Between 1998 and 2001 92 patients with idiopathic macular holes had been operated by one surgeon with different methods. At all patients a detachment of the posterior hyloid was achieved and 16% C2F6 was injected at the end. In group 1 (40 eyes) autologeous platelete concentrate was given after removal of a clinical visible membrane, if present. In group 2 (41 eyes) the ILM was completely removed around the macular hole with the help of ICG (1mg/ml). The mean follow up was 30 (4-147) weeks (group 1) and 17 (4-53) weeks (group 2).
Results: The rate of hole closure was 90 % in group 1 and 76 % in group 2. A significant improvement (three or more lines = doubling of angle) of visual acuity was found in 40 % of patients in group 1 and in 15 % of patients in group 2. A significant worsening (three or more lines) of visual acuity took place in 10 % of patients in group 1 and in 34 % of patients in group 2. The only complication was a retinal detachment in 1 out of 81 patients. Seven patients (five after ICG and two after platelets) underwent a second surgery with use of platelets because of lacking closure of the macular hole, which finally led to a closure in 3/5 and 1/2 patients respectively.
Conclusions: Visual acuity is significant better after use of platelet concentrate. Toxicity of ICG can not be excluded based on the results of this study.