J Korean Ophthalmol Soc.  2015 Oct;56(10):1572-1579. 10.3341/jkos.2015.56.10.1572.

Clinical Outcomes of Minimal Exposure to Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane

• Chung HY
• Sohn GS
• Lee KM
• Hwang DJ
• Sohn JH
• Park YS

• KMID: 2214417
• DOI: http://doi.org/10.3341/jkos.2015.56.10.1572

Abstract

PURPOSE
To evaluate the clinical outcomes of epiretinal membrane (ERM) surgery with minimal exposure to indocyanine green (ICG) dye-assisted internal limiting membrane (ILM) peeling compared with no ICG dye.
METHODS
We divided 33 eyes with ERM treated by vitrectomy into 2 groups. ICG dye was used in the first group of 18 eyes (ICG group) but not in the second group of 15 eyes (no dye [ND] group). In the ICG group, 0.25% diluted ICG dye was injected into the fluid-filled eye and removed with a back-flushing needle after 3-5 seconds to peel ILM. Value changes in several parameters including visual acuity, central macular thickness, Humphrey automated kinetic perimetric analysis, and peripapillary retinal nerve fiber layer (RNFL) thickness were followed up and compared according to ICG dye use.
RESULTS
No differences were found between the 2 groups in terms of visual acuity, central macular thickness, and peripapillary RNFL thickness preoperatively and at 6 months postoperatively (p = 0.125 for visual acuity, p = 0.734 for central macular thickness, p = 0.615 for RNFL thickness). Six months after surgery, no significant increase was found in any region of visual field in the ICG group (p = 0.392). The visual field was significantly increased in the superior region in the ND group (p = 0.042). The RNFL thickness in the temporal quadrant was significantly reduced at 6 months postoperatively compared to baseline values in both groups (p = 0.011 for ICG group, p = 0.042 for ND group).
CONCLUSIONS
ICG dye-assisted ILM peeling does not aggravate clinical outcomes of ERM surgery in terms of visual acuity, central macular thickness, visual fields, or RNFL thickness and can be safely utilized with proper techniques.

Keyword

Epiretinal membrane; Indocyanine green; Visual field

MeSH Terms

Epiretinal Membrane
Indocyanine Green
Membranes*
Needles
Nerve Fibers
Retinaldehyde
Visual Acuity
Visual Fields
Vitrectomy
Indocyanine Green
Retinaldehyde

Figure

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  Figure 1. Measuring the size of epiretinal membrane with red-free fundus photography and the Photoshop program (Photoshop 5.5, Adobe Systems Inc., San Jose, CA, USA). The selected area (dotted line) is expressed in pixels (red arrow) by the histogram option.

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  Figure 2. Changes of visual fields according to regions and study points in the indocyanine green (ICG) group (A), and in the ND group (B). Superior visual fields significantly improved at 6 months after surgery in the ND group. ICG group is indocyanine green dye assisted internal limiting membrane peeling and ND group is internal limiting membrane peeling without staining. ND = no dye; Pre = preoperative period; M = months.

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  Figure 3. Changes of preoperative and postoperative total visu-al fields. There was no significant difference between the groups. ICG group is indocyanine green dye assisted internal limiting membrane peeling and ND group is internal limiting membrane peeling without staining. ICG = indocyanine green. ND = no dye; Pre = preoperative period; M = months.

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  Figure 4. Changes of nerve fiber layer thickness according to regions and study points in the ICG group (A), and in the ND group (B). It showed that temporal peripapillary RNFL thickness were significantly thinning at 3 months and 6 months in both groups. ICG group is indocyanine green dye assisted internal limiting membrane peeling and ND group is internal limiting membrane peeling without staining. ICG = indocyanine green; ND = no dye; RNFL = retinal nerve fiber layer; Pre = preoperative period; M = months.

Reference

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