Anatomical and visual outcomes of idiopathic macular hole surgery with internal limiting membrane removal using low-concentration indocyanine green

Abstract

Purpose: To report the anatomical, visual, and optical coherence tomography (OCT) results of using a brief application of a low concentration of indocyanine green (ICG) to assist the removal of internal limiting membrane (ILM) during idiopathic macular hole repair.

Methods: Retrospective, interventional, noncomparative case series of 59 eyes of 57 patients with stage 2, 3, or 4 idiopathic macular holes who underwent pars plana vitrectomy with removal of ILM assisted by a brief (<30 seconds) intravitreal application of 0.125% (1.25 mg/mL) ICG.

Results: The median follow-up period was 13 months (range, 2-40 months). Anatomical closure of the macular hole was achieved in 58 eyes (98%) with a single surgery. Visual acuity improved from a preoperative mean of 20/100 to 20/60 postoperatively (P < 0.0001). Twenty-nine eyes (49%) had postoperative visual acuity of 20/50 or better. Visual acuity improved by > or =2 lines in 43 eyes (73%) and between 0 and 2 lines in 13 eyes (22%) and decreased in 3 eyes (5%). Postoperative OCT showed closure of macular hole with normal foveal depression in 49 (89%) of 55 eyes.

Conclusion: A brief application of ICG at a low concentration appears to provide a safe and effective way of assisting ILM peeling during idiopathic macular hole surgery.