Macular hole surgery with and without indocyanine green assistance

Abstract

Purpose: To compare the results of macular hole surgery with the use of indocyanine green (ICG) to assist internal limiting membrane (ILM) peeling and macular hole surgery without indocyanine green use.

Methods: A retrospective, comparative, consecutive study of 68 patients with macular holes. In total, 34 patients underwent vitrectomy and ILM peeling, and 34 patients underwent vitrectomy and ILM peeling with the assistance of indocyanine green. The main outcome measures were postoperative visual acuity and macular hole status.

Results: Indocyanine green increased the ability to visualise and peel the ILM. The average preoperative visual acuity in the group where ICG was used was 6/36 and the group where ICG was not used was 6/60. The average follow-up was 25 weeks for the ICG group and 53 weeks for the group with no ICG. Both groups were also compared at 25 weeks follow-up. Hole closure rate for the group with ICG was 97% compared to 91% without ICG. The mean postoperative visual acuity was 6/24 for the group with ICG and 6/12 for the group without ICG, a difference of two lines on the Snellen chart when compared with the preoperative acuity (P-value 0.299, Student's t-test). Both groups had a mean improvement of Snellen acuity of two lines (ICG group: P-value 0.0002, Student's t-test; no ICG group: P-value 0.00004, Student's t-test). In all, 83% of patients in the ICG group maintained or improved their visual acuity compared to 91% in the group without ICG.

Discussion: There is no doubt that indocyanine green stains and assists in visualisation and therefore increases the ease of peeling the ILM in macular hole surgery. Initially, there was concern regarding a poorer outcome for patients with the use of ICG, which has also been previously discussed in the literature. When the two groups were compared at a similar follow-up time of approximately 25 weeks, it was shown that there was no statistically significant difference between the outcomes in the two groups. This study had an improved hole closure rate for the group where ICG was used, although it was not statistically significant.