To investigate the efficacy of 25-gauge infracyanine green–assisted idiopathic macular pucker surgery and to identify prognostic factors.
Methods
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.
Results
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.
Conclusions
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.
FujiiG.Y., De JuanE.Jr, HumayunM.S.Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery.Ophthalmology2002; 109: 1814–20.
GandorferA., HaritoglouC., GandorferA., KampikA.Retinal damage from indocyanine green in experimental macular surgery.Invest Ophthalmol Vis Sci2003; 44: 316–23.
8.
SippyB.D., EngelbrechtN.E., HubbardG.B.Indocyanine green effect on cultured human retinal pigment epithelial cells: implication for macular hole surgery.Am J Ophthalmol2001; 132: 433–5.
9.
MaiaM., HallerJ.A., PieramiciD.J.Retinal pigment epithelial abnormalities after internal limiting membrane peeling guided by indocyanine green staining.Retina2004; 24: 157–60.
10.
TokudaK., TsukamotoT., FujisawaS., MatsubaraM.Evaluation of toxicity due to vital stains in isolated rat retinas.Acta Ophthalmol Scand2004; 82: 189–94.
11.
IriyamaA., UchidaS., YanagiY.Effects of indocyanine green on retinal ganglion cells.Invest Ophthalmol Vis Sci2004; 45: 943–7.
12.
HaritoglouC., GandorferA., GassC.A., SchaumbergerM., UlbigM.W., KampikA.Indocyanine green-assisted peeling of the internal limiting membrane in macular hole surgery affects visual outcome: a clinicopathologic correlation.Am J Ophthalmol2002; 134: 836–41.
13.
StalmansP., Van AkenE.H., VeckeneerM., FeronE.J., StalmansI.Toxic effect of indocyanine green on retinal pigment epithelium related to osmotic effects of the solvent.Am J Ophthalmol2002; 134: 282–5.
14.
HaritoglouC., GandorferA., SchaumbergerM., TadayoniR., GandorferA., KampikA.Light-absorbing properties and osmolarity of indocyanine-green depending on concentration and solvent medium.Invest Ophthalmol Vis Sci2003; 44: 2722–9.
15.
LanzettaP., PolitoA., Del BorrelloM.Idiopathic macular hole surgery with low-concentration infracyanine green-assisted peeling of the internal limiting membrane.Am J Ophthalmol2006; 142: 771–6.
16.
ParkD.W., DugelP.U., GardaJ.Macular pucker removal with and without internal limiting membrane peeling: pilot study.Ophthalmology2003; 110: 62–4.
17.
FeldmanA., ZerbibJ., Glacet-BernardA., HaymannP., SoubraneG.Clinical evaluation of the use of infracyanine green staining for internal limiting membrane peeling in epimacular membrane surgery.Eur J Ophthalmol2008; 18: 972–9.
18.
FarahM.E., MaiaM., RodriguesE.B.Dyes in ocular surgery: principles for use in chromovitrectomy.Am J Ophthalmol2009; 148: 332–40.
19.
Da MataA.P., RiemannC.D., NehemyM.B., FosterR.E., PetersenM.R., BurkS.E.Indocyanine green-assisted internal limiting membrane peeling for macular holes to stain or not to stain?Retina2005; 25: 395–404.
20.
KoutsandreaC.N., ApostolopoulosM.N., AlonistiotisD.A.Indocyanine green-assisted epiretinal membrane peeling evaluated by optical coherence tomography and multifocal electroretinography.Clin Ophthalmol2007; 1: 535–44.
21.
SorcinelliR.Surgical management of epiretinal membrane with indocyanine-green-assisted peeling.Ophthalmologica2003; 217: 107–10.
22.
KoestingerA., BoveyE.H.Visual acuity after vitrectomy and epiretinal membrane peeling with or without premacular indocyanine green injection.Eur J Ophthalmol2005; 15: 795–9.
23.
HillenkampJ., SaikiaP., GoraF.Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green.Br J Ophthalmol2005; 89: 437–43.
24.
KwokA.K., LaiT.Y., LiW.W., WooD.C., ChanN.R.Indocyanine green-assisted internal limiting membrane removal in epiretinal membrane surgery: a clinical and histologic study.Am J Ophthalmol2004; 138: 194–9.
25.
KwokA.K., LaiT.Y., LiW.W., YewD.T., WongV.W.Trypan blue- and indocyanine green-assisted epiretinal membrane surgery: clinical and histopathological studies.Eye2004; 18: 882–8.
26.
HaritoglouC., EiblK., SchaumbergerM.Functional outcome after trypan blue-assisted vitrectomy for macular pucker: a prospective, randomized, comparative trial.Am J Ophthalmol2004; 138: 1–5.
27.
KadonosonoK., YamakawaT., UchioE., YanagiY., TamakiY., AraieM.Comparison of visual function after epiretinal membrane removal by 20-gauge and 25-gauge vitrectomy.Am J Ophthalmol2006; 142: 513–5.
28.
HaritoglouC., GandorferA., SchaumbergerM.Trypan blue in macular pucker surgery: an evaluation of histology and functional outcome.Retina2004; 24: 582–90.
29.
MassinP., AllouchC., HaouchineB.Optical coherence tomography of idiopathic macular epiretinal membranes before and after surgery.Am J Ophthalmol2000; 130: 732–9.
30.
SuhM.H., SeoJ.M., ParkK.H., YuH.G.Associations between macular findings by optical coherence tomography and visual outcomes after epiretinal membrane removal.Am J Ophthalmol2009; 147: 473–80.
WilkinsJ.R., PuliafitoC.A., HeeM.R.Characterization of epiretinal membranes using optical coherence tomography.Ophthalmology1996; 103: 2142–51.
33.
KimJ., RheeK.M., WooS.J., YuY.S., ChungH., ParkK.H.Long-term temporal changes of macular thickness and visual outcome after vitrectomy for idiopathic epiretinal membrane.Am J Ophthalmol2010; 150: 701–9.
34.
WongJ.G., SachdevN., BeaumontP.E., ChangA.A.Visual outcomes following vitrectomy and peeling of epiretinal membrane.Clin Experiment Ophthalmol2005; 33: 373–8.
35.
RiceT.A., De BustrosS., MichelsR.G., ThompsonJ.T., DebanneS.M., RowlandD.Y.Prognostic factors in vitrectomy for epiretinal membranes of the macula.Ophthalmology1986; 93: 602–10.
36.
InoueM., MoritaS., WatanabeY.Inner segment/outer segment junction assessed by spectral-domain optical coherence tomography in patients with idiopathic epiretinal membrane.Am J Ophthalmol2010; 150: 834–9.
37.
MitamuraY., HiranoK., BabaT., YamamotoS.Correlation of visual recovery with presence of photoreceptor inner/outer segment junction in optical coherence images after epiretinal membrane surgery.Br J Ophthalmol2009; 93: 171–5.
