Changes in Retinal Pigment Epithelium After Indocyanine Green–Assisted Internal Limiting Lamina Peeling During Macular Hole Surgery

Abstract

To determine the changes in the retinal pigment epithelium (retinal pigment epithelium) and secondary changes in the choroid and fovea after indocyanine green (ICG) staining of the internal limiting lamina during surgery for an idiopathic macular hole (MH). Observational case series. The medical charts of 31 patients who underwent MH surgical procedures with internal limiting lamina staining and peeling were reviewed. The eyes were examined by optical coherence tomography, scanning laser ophthalmoscopy, fluorescein, and ICG angiography. In three cases that experienced retinal pigment epithelium changes, there was foveal thinning and choriocapillary atrophy in the area of the previous MH. The visual acuity was markedly worse, and the retina was markedly thinner in these three cases than in the other cases without retinal pigment epithelium changes (P = .003, P = .009, respectively). The use of ICG dye with illumination may increase the risk of retinal pigment epithelium damage and secondary choroidal and foveal morphologic changes.