Abstract
We describe the utilization of indocyanine green (ICG) dye to facilitate combined/en bloc removal of epiretinal membranes (ERM) along with internal limiting membranes (ILM). The method utilizes a highly diluted preparation of ICG in dextrose water solvent (D5W). Elimination of fluid air exchange step facilitating staining in the fluid phase and low intensity lighting help minimize potential ICG toxicity. The technique demonstrates how ICG facilitates negative staining of ERMs and how ILM peeling concomitantly can allow complete and efficient ERM removal minimizing surgical time and the necessity for dual or sequential staining.
Highlights
Epiretinal membranes (ERM) represent a cellular proliferation on the inner retinal surface
Benefits to internal limiting membranes (ILM) peeling have been suggested in other disease processes frequently presenting concomitantly with ERM such as macular hole and diabetic macular edema.[4,5]
ILM peeling has been shown to possibly decrease the rate of epiretinal membrane recurrence[3] and has been shown to be beneficial in epiretinal membranes presenting with concomitant pathologies such as diabetic macular edema and macular hole.[4,5]
Summary
Epiretinal membranes (ERM) represent a cellular proliferation on the inner retinal surface. Indocyanine green (ICG) readily stains the ILM, it only faintly stains ERMs. we describe a negative staining technique using highly diluted ICG to facilitate demarcation and removal of epiretinal membranes concomitant with internal limiting membrane peel. A macular contact lens is placed and 23 gauge disposable forceps are used to initiate an ILM flap outside of the ERM using a pinch and peel technique [Figure 2] This flap is subsequently enlarged to the appropriate diameter for a complete peel. This effectively allows the removal of the ILM and ERM en bloc [Figure 4] This technique bypasses the need for sequential or dual staining as well as the number of contact sites required between the tip of the forceps and the retinal surface. A partial air fluid exchange is performed, and sutureless closure of the scleral wounds is achieved [Video 1]
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