Ocular hypotony after the use of indocyanine green for epiretinal membrane surgery

Abstract

Purpose: To report the occurrence of transient ocular hypotony after indocyanine green (ICG)-assisted macular surgery for removal of the epiretinal membrane (ERM).Materials and methods: This was a retrospective review of 122 eyes of 118 patients who underwent vitrectomy for idiopathic ERM. The ICG staining technique was used in 71 eyes without fluid–air exchange (FAX) and in 15 eyes with FAX. Detailed eye examinations, including intraocular pressure (IOP) measurement, were performed before and after surgery.Results: We observed postoperative transient ocular hypotony with choroidal detachment in 8 of 71 eyes (11%) in the ICG (+)/FAX (−) group, and no ocular hypotony was seen in the ICG (+)/FAX (+) group (15 eyes) or in the ICG (−) group (36 eyes). The median best corrected visual acuity (BCVA) in the ICG(−)group was only significantly better than in the ICG (+)/FAX (−) with hypotony at 1 week after surgery (p = 0.046). However, there was no statistically significant difference in BCVA at 3 and 6 months after surgery among the groups (p > 0.05).Conclusion: ICG staining of the internal limiting membrane (ILM) supports complete ERM removal because of enhanced visualization of the border between the ILM and the ERM. However, it should be cautioned that postoperative ocular hypotony may occur in some cases of ICG-assisted macular surgery. Therefore, informed consent with careful follow-up is required when ICG-assisted surgery is performed.