Clinical evaluation of the use of infracyanine green staining for internal limiting membrane peeling in epimacular membrane surgery

PURPOSE. To evaluate the use of infracyanine green (IFCG) staining in idiopathic epiretinal membrane (ERM) surgery. METHODS. A retrospective comparative study of 63 consecutive eyes with ERM operated on with internal limiting membrane (ILM) peeling using or not filtered IFCG diluted (5: 1) in glucose 5%. Main outcome measures were best-corrected visual acuity, central visual field perimetry, fluorescein angiography with blue light fundus photograph, optical coherence tomography (OCT), and in seven eyes multifocal electroretinogram (mfERG). RESULTS. A total of 44 eyes underwent surgery with ILM staining using IFCG and 19 eyes without. In the IFCG group, the staining showed that the ILM was removed together with the ERM in 39% of eyes; ILM was still present on the macula after ERM removal in 57% of eyes and removed secondarily. The improvement in vision was slightly better in the IFCG group throughout follow-up but the difference was not significant. On the postoperative blue light photograph, defects in the optic nerve fibre layer were less frequent in the group with IFCG than without (p=0.023), suggesting less peroperative trauma. Two eyes in the group operated without IFCG had recurrence of the ERM including one with a macular hole vs none in the group with IFCG. No difference was observed in the groups as regards central visual field testing, mfERG, OCT, or angiographic data. CONCLUSIONS. Using IFCG for ILM peeling in ERM surgery seemed to reduce significantly the trauma to the optic nerve fiber layer and to prevent ERM recurrence. Deleterious effects were not observed in this study. (Eur J Ophthalmol 2008; 18: 972-9)