Endoilluminator phototoxic maculopathy associated with combined ICG-assisted epiretinal membrane and internal limiting membrane peeling (original) (raw)
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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.
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...
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.
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.
Persistent indocyanine green fluorescence after vitrectomy for macular hole
American Journal of Ophthalmology, 2003
In both cases, no fluorescence was detected in the fundus of unoperated eyes. A standard pars plana vitrectomy was performed, followed by separation of the posterior hyaloid. Twenty-five mg of sterile ICG (Diagnogreen Injection, Daiichi Pharmaceutical, Tokyo, Japan) was dissolved in 1 ml of distilled water, and then this solution was mixed with 4 ml of balanced salt solution. The dye we used has a molecular weight of 774.96 d and has its peak absorption at 785 nm dissolved in nonprotein-containing solvents, 805 nm in plasma. After the vitrectomy, under clipping the infusion port temporarily, a small amount of the 5.0-mg/ml ICG solution was placed on the macular region. Immediately after injection of ICG, remaining dye in the vitreous cavity was flushed completely. A 3 disk diameter or larger section of the green-stained internal limiting membrane at the macular region was peeled using end-gripping forceps. No complication was observed during surgery. Histologic examinations confirmed that the peeled specimens were definitely internal limiting membrane tissue.
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.