The effect of indocyanine-green on functional outcome of macular pucker urgery

Purpoe To compare functional reult after urgery for macular pucker either with or without indocyanine-green taining of the internal limiting membrane (ILM) and to evaluate the ultratructure of the tiue removed. Deign Retropective analyi of two ucceive, conecutive, interventional cae erie. Method Functional outcome (viual acuity, Goldmann perimetry) of 48 eye of 48 conecutive patient with (group 1, N = 20) or without (group 2, N = 28) intraoperative ue of indocyanine-green (ICG) wa retropectively analyzed. For tatitical analyi, bet-corrected viual acuity meaured at the lat preentation wa conidered. Only patient with an idiopathic macular pucker were included. urgery conited of three-port par plana vitrectomy, and removal of epiretinal tiue and the ILM in a econd tep. Commercially available ICG with a concentration of .05% and an omolarity of 275 mOm wa ued to tain the ILM. The urgical technique ued for both group wa identical, except the ue of ICG. Epiretinal tiue of all eye wa harveted and prepared for ultratructural analyi uing light and electron microcopy. Reult Follow-up time wa 8.5 month in group 1 and 5.4 month in group 2. Wherea patient operated on without ICG experienced a ignificant improvement of median bet-corrected viual acuity from 20/63 (range, 20/400 to 20/32) preoperatively to 20/40 (range, 20/200 to 20/25) potoperatively (P < .001), median bet-corrected viual acuity remained 20/63 before (range, 20/200 to 20/63) and after (range, 20/400 to 20/20) (P > .9) ICG-aited peeling. There wa a tatitically ignificant difference (P = .013) in bet-corrected potoperative viual acuity of patient with and without the ue of ICG. An improvement of viion wa noted in 86% of patient without and 55% of patient with ICG-aited urgery. Thirty-five percent of patient after ICG application preented with a deterioration of viual acuity. Furthermore, we oberved large viual field defect in 7 of 20 patient after ILM taining. No viual field defect were noted after conventional peeling. Hitologic analyi revealed clear difference between the two group concerning the amount of cellular element adjacent to the retinal urface of the ILM: There wa more cellular debri viible in pecimen after ICG application during urgery. Additionally, in contrat to urgery without ILM taining, epiretinal cell had ruptured and lot their cellular integrity after ICG-aited vitrectomy. Concluion Indocyanine green-aited urgery for macular pucker might have an advere effect on functional outcome. Although there were obviou difference in the ultratructure of tiue removed during urgery, our obervation cannot be explained by hitologic analyi alone. Other, o far unknown mechanim of action mut be conidered.