Clinical outcomes of internal limiting membrane peel using indocyanine green (ICG) dissolved in 5% dextrose in water (D5W) during macular hole surgery.

摘要

Purpose : In an effort to reduce potential retinal toxicity from usage of intraoperative ICG, our study compares visual acuity outcomes of ICG that has been reconstituted with a sodium based fluid (BSS) versus ICG reconstituted with sodium-free fluid (D5W) during macular hole surgery. Methods : All idiopathic macular holes that underwent pars plana vitrectomy with membrane peel using ICG by one of four surgeon in a large private practice from 1997 to 2012 were reviewed. Patients with concurrent ocular disease or less than 6 mo follow-up were excluded. Holes were repaired either with ICG prepared with BSS, containing sodium at an isotonic concentration or ICG prepared with D5W, without sodium, but still isotonic to vitreous. To control for cataract, only patients noted to be without cataract at 12 months and pseudophakic patients were used in our analysis. Results were compared assessing anatomic closure of the hole, and pre-op and 12 mo post-op vision converted to logMar scale. Results : There were 32 patients in the BSS group and 84 patients in the D5W group. Pre-operative mean VA in the was 20/131 in the BSS group and 20/130 in the D5W group, respectively, with no statistical difference in VA between the groups (p=99.07). The 12 month postoperative mean VA was 20/61 BSS group and 20/57 in the D5W group respectively, with no statistical difference in VA between the groups (p=70.95). Individually, each group showed significant improvement in VA from preop to 12 months postop (BSS p=0.01; D5W p=0.0000009). At one year, closure rates were found to be 90.6% in the BSS group and 89.0% in the D5W group. Conclusions : Visual outcomes improved significantly in both groups when compared to their respective preoperative values. However, there was no difference in visual acuity between the two groups post-operatively. While the theory of ICG entering RPE cells through sodium channels, mixing ICG with dextrose does not seem to further improve outcomes beyond those of ICG when mixed with BSS. With ICG being the choice of ILM stain in the United States, there should be continued efforts to study ways to mitigate the potential toxicity of ICG. This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.