To investigate the safety and efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes

Abstract

To observe the efficacy of indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling for treatment of idiopathic macular epiretinal membranes(IMEM). Retrospectively studied 60 patients with IMEM who all underwent the surgery of vitrectomy combined with internal limiting membrane peeling from 2011 to 2013. Best corrected visual acuity (BCVA), intraocular pressure(NCT), slit-lamp examination, fundus photography, optical coherence tomography (OCT) were committed. Patients were followed for 6 months. They were divided into two groups according to whether indocyanine green(ICG) was used or not with 32 members in ICG group and 28 members in none ICG group. They were divided into two groups according to the intergrity or disruption of the ellipsoid zone (EZ band) with 26 members in EZ band intergrity group and 34 members in EZ band disruption group. Age ranged from 28 to 79 years and the average age was 60.3 ± 10.9. Twenty-five males and 35 females were included. Twenty-five left eyes and 35 right eyes were incorporate. Among the 60 patients, 38 cases (63.33%) underwent visual acuity improvement after operation(BCVA improved at least 2 rows) and 21 (35%)patients' vision remained the same(BCVA changes less than 2 rows), while only one patient(1.67%) experienced decreased visual acuity(BCVA decline at least 2 rows). Average best corrected visual acuity (BCVA) (LogMar)and central retina thickness(CRT) (μm)of all patients preoperationwere 0.85 ± 0.44 and 578.45±144.61 respectively, which were 0.57±0.40 , 466.31±87.80 for one month and 0.54±0.42, 442.33± 98.92 three and six months postoperation(P<0.05). Compared to group of disruption EZ band, the BCVA of group of integral EZ band was better(P<0.05). 15 of 26 members in group of integral EZ band came up with EZ band cells loss in one month after operation and recovered by three or six months later. There was no statistical significance in BCVA and CRT between ICG group and none ICG group(P<0.05). Indocyanine green-assisted vitrectomy combined with internal limiting membrane peeling in the treatment of IMEM is safe and effective. The symptoms of decreased vision, metamorphopsia were greatly ameliorated. Besides, retinal organization structures showed a certain extent of improvement. The transient occurrence of EZ band disruption postoperation could recovery 3 to 6 months later. And internal limiting membrane peeling assisted with ICG is a promising approach to the accomplishment of surgery without obvious toxicity. (Chin J Ophthalmol, 2016, 52:366-372).