Abstract
We welcome the opportunity to comment on our article. We agree with Dr. Weinberger that the indocyanine green (ICG) fluorescence observed in the central macula is due to ICG uptake of retinal pigment epithelium cells exposed to the ICG during the surgery. We have proved in experimental studies that ICG stains human retinal pigment epithelium cell cultures, and that the ICG fluorescence in the retinal pigment epithelium cells is proportional to the concentration of the ICG in the solution and to the time that the retinal pigment epithelium cells are exposed to the ICG solution. We noted this pattern of persistent ICG fluorescence under the fovea only after surgery for macular hole and not after surgery for epiretinal membrane peeling. We think that a solution of continuity in the fovea is necessary to allow contact between the ICG and the retinal pigment epithelium cells. We have seen persistent fluorescence of the internal limiting membrane (ILM), and of the optic nerve. We agree with Dr. Weinberger that there may be axonal ICG transport. However, we routinely make sure to have a complete posterior vitreous detachment during macular hole surgery, and we do not think that the presence of a complete posterior vitreous detachment prevent ICG staining.
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