Long-term visual outcome after pars plana vitrectomy and ILM-Peeling with or without Indocyanine green

Abstract

PURPOSE: The intraoperative use of intravitreal indocyanine green (ICG) to dye the internal limiting membrane (ILM) to assist its peeling remains an ongoing debate. The purpose of this study was to investigate long-term visual outcomes in patients who underwent ILM-peeling with or without the use of ICG. METHODS: 301 eyes of 294 consecutive, nonrandomized patients with a follow-up period of at least 6 months were included into a retrospective study. 135 eyes suffered from idiopathic macular hole, 166 eyes had a macular pucker. In the macular hole-group ICG was used to stain the ILM of 117 eyes, while the macular pucker-group contained 111 eyes. 18 eyes with macular hole and 55 eyes with macular pucker underwent the identical procedure without the use of ICG. Follow-up examinations included testing for best corrected visual acuity (BCVA) and indirect ophthalmoscopy. RESULTS: Postoperative change in visual acuity (VA) was recorded 6 month after surgery in all patients. Mean last follow-up was 1.74 years after surgery (range 0.5–7 years). In macular hole-surgery with ICG median visual acuity increased from 0.13 (logMar 0.9) preoperatively to 0.25 (logMar 0.6) postoperatively after an average of 1.74 years. In the macular hole group operated without ICG median visual acuity remained unchanged at 0.2 (logMar 0.7). Also in the macular pucker group median visual acuity improved in the group with ICG from 0.3 (logMar 0.5) pre- to 0.4 (logMar 0.4) postoperatively after 1.74 years in average; in the group without ICG median visual acuity also remained stable at 0.4 (logMar 0.4) pre- as well as postoperatively at all quoted times. There was no statistically significant difference in visual outcome between procedures with or without ICG staining (p = 0.27). CONCLUSION: This study suggests a trend towards better visual outcomes with ICG-assisted ILM peeling. This may imply, if handled appropriately, potential ICG toxicity be negligible over same or better visual outcomes for the patient.