Low-Concentration Infracyanine Green–Assisted Internal Limiting Membrane Peeling in Idiopathic Macular Pucker 25-Gauge Surgery

Abstract

To investigate the efficacy of 25-gauge infracyanine green-assisted idiopathic macular pucker surgery and to identify prognostic factors. In this retrospective interventional case series, 83 patients with idiopathic macular pucker who underwent 25-gauge surgery with infracyanine green-assisted internal limiting membrane (ILM) peeling were retrospectively reviewed. Best-corrected visual acuity (BCVA) measurement, complete ophthalmologic evaluation, and optical coherence tomography were performed at baseline and during follow-up. Preoperative and postoperative prognostic factors were correlated with final visual outcomes. Mean follow-up was 10.5 months (range 3-44). Best-corrected visual acuity improved from 0.56±0.27 logMAR (±SD) to 0.26 ±0.18 logMAR (p<0.001); central retinal thickness decreased from 441±115 µm to 355±72 µm (p<0.001). Greater postoperative visual gain was correlated with baseline BCVA (r=-0.65, p<0.0001), and BCVA gain after 1 week (r=0.64, p<0.0001) and 1 month (r=0.58, p<0.0001). Final BCVA was influenced by baseline BCVA (r=0.46, p<0.0001), BCVA change after 1 month (r=0.34, p=0.002), and presence of intraretinal fluid (r=0.28, p=0.01). No cases of endophthalmitis, retinal tears, or retinal detachments were reported. Low-concentration infracyanine green-assisted ILM peeling during minimally invasive surgery is associated with significant visual acuity improvement. Preoperative BCVA and optical coherence tomography appearance may be helpful in predicting the final visual outcome.