Indocyanine green-aited peeling of the internal limiting membrane in macular hole urgery affect viual outcome: a clinicopathologic correlation

Purpoe To report the ultratructure of the internal limiting membrane (ILM) after macular hole urgery with indocyanine green (ICG) taining and to invetigate an aociation with the potoperative functional outcome. Deign Retropective, noncomparative analyi of a conecutive cae erie. Method Twenty eye of 20 patient after macular hole urgery with ICG taining were included. Viual acuity and Goldmann perimetry were obtained before and after urgery. The ILM wa obtained during three-port par plana vitrectomy for idiopathic macular hole. Twenty-five milligram of terile ICG powder wa diolved in 5 ml of terile water a recommended by the manufacturer and then diluted in balanced alt olution. The ultratructure of the ILM wa analyzed uing light and tranmiion electron microcopy. Omolarity and pH of the ICG olution were meaured preoperatively. Reult There wa no tatitically ignificant improvement of potoperative viual acuity after ICG-aited peeling (P = .755). In even patient, potoperative viual field defect occurred. Indocyanine green-tained pecimen revealed cellular element reembling the plama membrane of Müller cell and other undetermined retinal tructure adherent to the retinal ide of the ILM. Hitologic finding dicloed no difference between patient with and without viual field defect after the ue of ICG. The omolarity of the ICG olution applied wa 275 mOm; pH wa 7.5. Concluion Intravitreal application of ICG may caue retinal damage by altering the cleavage plane to the innermot retinal layer. That may reult in le improvement of viual acuity and unexpected viual field defect. The underlying mechanim of action remain unclear and are the ubject of ongoing invetigation.