Macular hole surgery with or without indocyanine green stained internal limiting membrane peeling (original) (raw)
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To evaluate the anatomical success of stage 3 and 4 macular hole surgery after removal of internal limiting membrane (ILM) with the help of Indocyanine green (ICG). STUDY DESIGN An experimental study. PLACE AND DURATION OF STUDY LRBTTertiary Care Eye Hospital, Karachi, October 2015 to August 2016. METHODOLOGY Twenty patients with stage 3 and 4 macular hole (confirmed by spectral domain optical coherence tomography) underwent standard 3 ports pars plana vitrectomy. Staining of ILM was performed with the help of 0.5% ICG to aid in visualization. ILM was removed by using intraocular forceps in circular fashion. Finally, gas fluid exchange with internal tamponade of SF6 20% was performed. Postoperative face down posture was maintained for seven days. Patients were followed-up for 8 months and assessment of macular hole closure was done using SD-OCT. RESULTS After a follow-up of 8 months, macular hole was closed in 17 eyes (85%) and vision had improved in 6 patients. Postoperat...
American Journal of Ophthalmology, 2002
PURPOSE: To report the results of macular hole surgery using indocyanine green to improve visualization and facilitate peeling of the internal limiting membrane. • METHODS: A retrospective noncomparative review of a consecutive series of 22 patients (22 eyes) who underwent macular hole repair using indocyanine green to facilitate visualization of the internal limiting membrane was performed. One patient was excluded because of a history of a rhegmatogenous retinal detachment. All patients underwent a three-port pars plana vitrectomy with internal limiting membrane peeling. Indocyanine green (0.1% solution) was used to assist in the visualization of the internal limiting membrane. The main outcome measures were postoperative visual acuity, macular hole status, and postoperative retinal pigment epithelial changes. • RESULTS: In 21 eyes, the median preoperative bestcorrected visual acuity was 20/200 (range, 20/60 to counting fingers at 5 feet). The median postoperative visual acuity was 20/400 (range, 20/60 -1/200) with an average follow-up of 13 weeks. The macular hole was closed in 18 eyes (86%) at the most recent follow-up. Ten eyes were found to have atrophic retinal pigment epithelium changes in the area of the previous macular hole. • CONCLUSIONS: Indocyanine green assists in visualization of the internal limiting membrane in macular hole surgery. In our series, 10 eyes had unusual atrophic changes in the retinal pigment epithelium at the site of the previous macular hole, or in the area where the indocyanine green solution would have had direct access to the bare retinal pigment epithelium cells. Although the use of indocyanine green improves visualization and assists with peeling of the internal limiting membrane, the safety and potential toxicity of indocyanine green to the retinal pigment epithelium require further investigation. (Am J Ophthalmol 2002;133:89 -94.
BMC Ophthalmology, 2020
Background Internal limiting membrane (ILM) peeling increases the idiopathic macular hole (IMH) closure rate but causes the inner retina dimplings. This study is to introduce a method to minimally peel the ILM, and with the ILM flap to ensure the IMH closure. Methods Twelve consecutive IMH eyes were treated with the minimal ILM peeling with ILM flap technique. The ILM around the MH is peeled off in an annular shape with a width of approximately 200 to 300 μm. A tongue-shape ILM flap is created in the superior retina and the inferior margin of ILM is not peeled off. The ILM flap is then inverted to cover the MH, followed by fluid-air exchange and air or silicon tamponade. Spectral domain-optical coherence tomography (SD-OCT) and en face OCT for morphological assessment, best corrected visual acuity (BCVA) and multifocal electroretinogram (ERG) for functional evaluation were performed at baseline and at each postoperative follow-up. Results All the 12 eyes achieved macular hole closur...
Brilliant blue G-assisted peeling of the internal limiting membrane in macular hole surgery
Indian Journal of Ophthalmology, 2011
Dye-assisted internal limiting membrane (ILM) peeling and gas tamponade is the surgery of choice for idiopathic macular holes. Indocyanine green and trypan blue have been extensively used to stain the ILM. However, the retinal toxicity of indocyanine green and non-uniform staining with trypan blue has necessitated development of newer vital dyes. Brilliant blue G has recently been introduced as one such dye with adequate ILM staining and no reported retinal toxicity. We performed a 23-gauge pars plana vitrectomy with brilliant blue G-assisted ILM peeling in six patients with idiopathic macular holes, to assess the staining characteristics and short-term adverse effects of this dye. Adequate staining assisted in the complete removal of ILM and closure of macular holes in all cases. There was no evidence of intraoperative or postoperative dye-related toxicity. Brilliant blue G appears to be safe dye for ILM staining in macular hole surgery.
Assessment of Macular Function Following Internal Limiting Membrane Peeling With ILM Blue
Cureus, 2020
To evaluate clinical outcome after surgery of idiopathic epiretinal membranes (ERM) with internal limiting membrane (ILM) peeling using a commercial combination of Brilliant blue G (BBG, 0.25 mg/ml) with 4% polyethylene glycol (PEG). Methods It was a prospective, single-center study. Macular surgery was performed due to ERM (n = 18) by two experienced surgeons. Exclusion criteria were secondary ERM, previous retinal surgery and pharmacological treatment. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and multifocal ERG (RETIscan) were assessed at baseline and three months after surgery. Results The BCVA improved from baseline 0.4 ± 0.13 logMAR to 0.3 ± 0.2 logMAR after three months (p > 0.05). The mean central foveal thickness was reduced from 407 ± 85 μm to 366 ± 56 μm after three months (p > 0.05). At baseline, the mean P1 amplitude (nV/deg 2) was 53.5 ± 32.1 in ring 1 and 35.9 ± 20.1 in ring 2. Three months after surgery the mean P1 amplitude was comparable with 57.2 ± 16.3 in ring 1 and 38.0 ± 11.7 in ring 2 compared with the initial situation (p = 0.22 and p = 0.3, respectively). Conclusion BBG with 4% PEG can be used for ILM peeling in patients with idiopathic epiretinal membranes without any sign of short-term toxicity.
Internal limiting membrane peeling in macular hole surgery
Ophthalmology, 2001
Purpose: To review the current rationale for internal limiting membrane (ILM) peeling in macular hole (MH) surgery and to discuss the evidence base behind why, when, and how surgeons peel the ILM. Methods: Review of the current literature. Results: Pars plana vitrectomy is an effective treatment for idiopathic MH, and peeling of the ILM has been shown to improve closure rates and to prevent postoperative reopening. However, some authors argue against ILM peeling because it results in a number of changes in retinal structure and function and may not be necessary in all cases. Furthermore, the extent of ILM peeling optimally performed and the most favorable techniques to remove the ILM are uncertain. Several technique variations including ILM flaps, ILM scraping, and foveal sparing ILM peeling have been described as alternatives to conventional peeling in specific clinical scenarios. Conclusion: Internal limiting membrane peeling improves MH closure rates but can have several consequences on retinal structure and function. Adjuvants to aid peeling, instrumentation, technique, and experience may all alter the outcome. Hole size and other variables are important in assessing the requirement for peeling and potentially its extent. A variety of evolving alternatives to conventional peeling may improve outcomes and need further study.
Journal of Ophthalmology
Purpose. This study aimed to show the impact of different extents of internal limiting membrane (ILM) peeling on visual and anatomical outcomes following idiopathic full-thickness macular hole (FTMH) surgery. Methods. In this single-center prospective study, patients with idiopathic FTMH underwent standard pars plana vitrectomy with two different extents of ILM peeling: 2-disc diameters (DD) or 4 DD. The main outcome measures were the closure rate of the holes based on optical coherence tomography (OCT) findings at three months after surgery. Results. Forty eyes from 39 patients were enrolled in the study. After three months, anatomical closure was achieved in 78% and 76% eyes in 2 DD peel and 4 DD peel groups, respectively. From 29 eyes with macular hole index (MHI) ≤ 0.5, type 1 closure was achieved in 42% eyes receiving a 2 DD ILM peel, compared to 66% eyes receiving a 4 DD peel p=0.041. In comparison, this significant difference was not seen in the subgroup of MHI > 0.5 p=061...
Investigative Opthalmology & Visual Science, 2011
Study (FILMS) Group 5 PURPOSE. To determine whether internal limiting membrane (ILM) peeling is effective and cost effective compared with no peeling in patients with idiopathic stage 2 or 3 full-thickness maculay hole (FTMH). METHODS. This was a pragmatic multicenter randomized controlled trial. Eligible participants from nine centers were randomized to ILM peeling or no peeling (1:1 ratio) in addition to phacovitrectomy, including detachment and removal of the posterior hyaloid and gas tamponade. The primary outcome was distance visual acuity (VA) at 6 months after surgery. Secondary outcomes included hole closure, distance VA at other time points, near VA, contrast sensitivity, reading speed, reoperations, complications, resource use, and participant-reported health status, visual function, and costs. RESULTS. Of 141 participants randomized in nine centers, 127 (90%) completed the 6-month follow-up. Nonstatistically significant differences in distance visual acuity at 6 months were found between groups (mean difference, 4.8; 95% confidence interval [CI], Ϫ0.3 to 9.8; P ϭ 0.063). There was a significantly higher rate of hole closure in the ILM-peel group (56 [84%] vs. 31 [48%]) at 1 month (odds ratio [OR], 6.23; 95% CI, 2.64 -14.73; P Ͻ 0.001) with fewer reoperations (8 [12%] vs. 31 [48%]) performed by 6 months (OR, 0.14; 95% CI, 0.05-0.34; P Ͻ 0.001). Peeling the ILM is likely to be cost effective. CONCLUSIONS. There was no evidence of a difference in distance VA after the ILM peeling and no-ILM peeling techniques. An important benefit in favor of no ILM peeling was ruled out. Given the higher anatomic closure and lower reoperation rates in the ILM-peel group, ILM peeling seems to be the treatment of choice for idiopathic stage 2 to 3 FTMH. (Clinical Trials.gov number, NCT00286507.
World Journal of Retina and Vitreous, 2011
To evaluate and compare the anatomical and functional outcomes of internal limiting membrane (ILM) peeling in macular hole surgery (MHS) assisted by Brilliant Blue G (BBG) or triamcinolone acetonide (TA). Study design: Retrospective, non-randomized, interventional single center study. Methods: 51 eyes of 51 patients with idiopathic macular holes (≥ stage 2) who underwent MHS at our center were included. An OCT evaluation of hole status was followed by pars plana vitrectomy for each of these eyes. Those who underwent TA-assisted ILM peeling were considered as group 1 (n = 26) and those with BBG-assisted ILM peeling were considered as group 2 (n = 25). The primary outcome measures included anatomical hole closure, postoperative visual acuity and operative complications for either group. Results: Anatomical hole closure was achieved in 46 eyes (90%). The mean postoperative follow-up duration was 15.9 ± 2.3 months. The mean preoperative visual acuity was 1.0702 ± 0.37 Log MAR (equivalent to 20/240) and the final acuity was 0.7122 ± 0.22 Log MAR (equivalent to 20/100) (p < 0.0001). There were no significant postoperative complications apart from progression of nuclear sclerosis in 8/35 phakic eyes. After adjusting for age and preoperative visual acuity, there was no significant difference between the two groups with respect to hole closure rate and postoperative visual acuity. Conclusion: BBG-assisted ILM peeling offers an effective alternative to triamcinolone with the added advantage of marked enhancement of vitreoretinal interface contrast with comparable hole closure rates and visual outcomes.
Long-term Retention of Dye After Indocyanine Green-Assisted Internal Limiting Membrane Peeling
Japanese Journal of Ophthalmology, 2006
Purpose: To evaluate dye retention in the fundus after indocyanine green (ICG)-assisted internal limiting membrane peeling. Methods: Ten eyes with stage 3 or 4 nondiabetic idiopathic macular hole (MH group) and six eyes with diffuse diabetic macular edema (DM group) were studied. The fundus was examined with 780-nm infrared illumination by a scanning laser ophthalmoscope (SLO) after ICG-assisted internal limiting membrane peeling. The postoperative follow-up period ranged from 6 to 12 months (mean ± SD, 3.7 ± 2.6 months). Results: Fluorescence from ICG was detected in all studied eyes in both groups up to 6 months after surgery. At 9 months after surgery, ICG fluorescence was visible in all eyes of the DM group, but in only one-third of eyes of the MH group. No fluorescence was detected in fellow eyes that had not been operated on. Conclusion: The present study using SLO revealed that ICG remains in the fundus for over 6 months after surgery. The results also suggested that a longer time might be required for dye clearance from the diabetic retina than from the nondiabetic retina.
Functional Outcome of Indocyanine Green-Assisted Macular Surgery
Retina, 2009
Purpose: To evaluate the long-term functional results after surgery for macular pucker and macular holes with indocyanine green (ICG) staining of the internal limiting membrane. Methods: Long-term functional and anatomical outcomes of 16 eyes of 16 patients were evaluated for 7.3 years after ICG-assisted macular surgery. Examinations performed included best-corrected visual acuity, Goldmann perimetry, Arden color contrast test, optical coherence tomography, and fundus photography. Ten eyes had undergone surgery for macular holes, and 6 eyes had been treated for macular pucker. Indocyanine green with a concentration of 0.05% and an osmolarity of 275 mOsm had been used to stain the internal limiting membrane. Results: Mean follow-up time was 7.3 years. Eighty-eight percent (14) of the eyes had undergone cataract surgery either in a combined intervention primarily (n ϭ 3) or in the years after the ICG-assisted macular surgery (n ϭ 11). One patient was still phakic with a pronounced cataract at last follow-up. Over all patients, best-corrected visual acuity did not increase significantly from 20/200 (median) before macular surgery to the present 20/70 (median). Large visual field defects (VFDs) were found in 10 of 16 patients after internal limiting membrane staining using ICG. In 8 of these 10 eyes, the VFDs had been diagnosed immediately after vitrectomy and remained unchanged throughout the period of review. In 2 eyes, a VFD was noted at the last follow-up visit despite an unremarkable Goldmann perimetry performed at follow-up visits after 3 months and 6 months. Pathologic color testing was found in 15 of 16 patients when comparing the operated and the fellow eye. A nonglaucomatous optic nerve atrophy was found in 11 of 16 eyes. The optical coherence tomography revealed macular hole closure in all 10 patients. Conclusion: Indocyanine green-assisted macular surgery might lead to optic nerve atrophy in the long-term and persistent VFDs. In addition, new VFDs may occur in the postoperative course. An affection of color vision also underlines the potential impact of ICG on visual function. A long-term observation of patients after ICG-assisted vitrectomy seems mandatory to reliably detect functional adverse events.
Evaluation of the Internal Limiting Membrane After Conventional Peeling During Macular Hole Surgery
Retina, 2006
We evaluated the histologic features of the internal limiting membrane (ILM) of the retina removed during macular hole surgery without indocyanine green staining. Our investigation focused on the presence or absence of retinal structures adherent to the retinal surface of the ILM. Because only tiny retinal cellular fragments were observed especially in ILM folds, we conclude that conventional ILM peeling can be performed safely with a cleavage plane between the retinal surface of the ILM and Mü ller cell endfeet.
BMC ophthalmology, 2018
The anatomical success rate of macular hole surgery ranges around 93-98%. However, the prognosis of large macular holes is generally poor. The study was conducted to compare the anatomical and visual outcomes of Internal Limiting Membrane (ILM) peeling vis-a-vis inverted ILM flap for the treatment of idiopathic large Full-Thickness Macular Holes (FTMH). This was a prospective randomized control trial. The study included patients with idiopathic FTMH, with a minimum diameter ranging from 600 to 1500 μm. The patients were randomized into Group A (ILM peeling) and Group B (inverted ILM flap). The main outcome measures were anatomical and visual outcome at the end of 6 months. Anatomical success was defined as flattening of macular hole with resolution of the subretinal cuff of fluid and neurosensory retina completely covering the fovea. There were 30 patients in each group. The mean minimum diameters in Group A and B were 759.97 ± 85.01 μm and 803.33 ± 120.65 μm respectively (p = 0.113...
Acta Ophthalmologica Scandinavica, 2004
Purpose: To report the functional and anatomic results of macular hole (MH) surgery complicated by massive subretinal migration of indocyanine green (ICG) dye. Design: Interventional case report. Methods: We performed standard pars plana vitrectomy surgery for a stage 3, senile idiopathic MH. After posterior vitreous detachment and vitreous removal, we instilled 2 ml of ICG (0.5%, 270 mOsm); the surgery was complicated by diffuse subretinal migration of the ICG dye but peeling of the internal limiting membrane (ILM) was performed (despite the obvious difficulties from the low contrast between the green-stained ILM overlying a green-stained subretinal space) and the rest of the procedure was completed with a final injection of 16% C 3 F 8 . Results: Post-surgical optical coherence tomography confirmed the anatomic closure of the MH. Digital photography with the excitation and barrier filters for ICG showed a striking autofluorescence along the inferior vascular arcade, which remained intense 7 months after surgery. Despite the massive subretinal migration of ICG, visual acuity (VA) improved to 20/30. Conclusions: This is the first report of VA recovery despite massive subretinal migration of ICG dye during MH surgery. Subretinal migration of ICG dye may be a potential complication during MH surgery; this should alert the surgeon to limit its use, despite the possible absence of clinically apparent toxic effects.