Indocyanine green-assisted ILM peeling in macular hole surgery revisited

PURPOSE: To report visual outcomes after peeling of the internal limiting membrane (ILM) using a brief application of low dose indocyanine green (ICG) for macular hole repair. DESIGN: Prospective, nonrandomized interventional case series. METHODS: A consecutive series of 16 eyes of 14 patients with full-thickness macular hole underwent vitrectomy and peeling of the ILM with an intravitreal application of 0.05% ICG for less than 10 seconds. RESULTS: The ILM could be removed uneventfully in 5 of 16 cases after a single ICG application and in 11 cases after a second ICG application. The macular hole was closed in 15 (93.7%) of 16 cases after a single surgery and in one case after a repeat surgery, as evaluated by optical coherence tomography. A significant visual acuity improvement was achieved as the mean logarithm of the minimum angle of resolution was from 0.600 preoperatively (equivalent to approximately 5/20 in the conventional 20 foot numerator form) to 0.213 (12/20) at the end of follow,up, (P < .0001). None of the cases developed peripheral visual field defect. Ophthalmoscopies or optic coherence tomographic images did not reveal any disruption at the level of the retinal pigment epithelium. CONCLUSIONS: A brief intravitreal application of low dose ICG may provide a safe ILM peeling in vitreomacular surgeries. (Am J Ophthalmol 2004;135:886-887. (C) 2004 by Elsevier Inc. All rights reserved.).