Indocyanine green staining may hinder final outcomes of macular hole surgery

Treating idiopathic macular holes using vitrectomy with indocyanine green-assisted peeling of the internal limiting membrane may result in slightly poorer final visual acuity and lead to more postop complications compared with surgery performed without the stain, a retrospective study suggests.

Norihiro Nagai, MD, and colleagues in Tokyo reviewed outcomes for 53 eyes of 47 patients treated for idiopathic macular holes. In all cases, surgeons performed vitrectomy and internal limiting membrane (ILM) peeling. Indocyanine green (ICG) staining was used during ILM peeling in 35 eyes of 31 patients, and 18 eyes of 16 patients underwent surgery without staining, according to the study.

Investigators found no significant differences in rates of macular hole closure or final visual acuity between the two groups. The initial surgery resulted in anatomical closure in 97% of ICG-stained eyes and in 94% of non-stained eyes, the authors reported.

However, significantly more eyes in the non-stained group achieved a final visual acuity of 20/25 or better. At 2 years follow-up, 15% of ICG-stained eyes and 44% of non-stained eye achieved 20/25 or better vision (P = .036).

Additionally, postoperative complications, including posterior retinal pigment epithelium atrophy, retinoschisis and visual field defects, were observed only in eyes that underwent ICG-assisted ILM peeling, according to the study.

"These results indicate that some consideration should be made before ICG is used in macular hole surgery," the authors said.

The study is published in the December issue of Acta Ophthalmologica Scandinavica.