Effect of Solvent in Indocyanine Green-Assisted Internal Limiting Membrane Peeling During Idiopathic Epiretinal Membrane Surgery

Mi Rae Kim; Ju Hong Park; Min Sagong; Woo Hyok Chang

doi:10.3341/jkos.2014.55.6.847

Journal List > J Korean Ophthalmol Soc > v.55(6) > 1009990

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Kim, Park, Sagong, and Chang: Effect of Solvent in Indocyanine Green-Assisted Internal Limiting Membrane Peeling During Idiopathic Epiretinal Membrane Surgery

Original Article

J Korean Ophthalmol Soc 2014;55(6):847-853.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.6.847

Effect of Solvent in Indocyanine Green-Assisted Internal Limiting Membrane Peeling During Idiopathic Epiretinal Membrane Surgery

Mi Rae Kim, MD, Ju Hong Park, MD, Min Sagong, MD, PhD, Woo Hyok Chang, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea

Address reprint requests to Woo Hyok Chang, MD, PhD, Department of Ophthalmology, Yeungnam University Medical, Center, #170 Hyeonchung-ro, Nam-gu, Daegu 705-703, Korea, Tel: 82-53-620-3445, Fax: 82-53-626-5936, E-mail: changwh@ynu.ac.kr

Received 4 October 2013 Revised 1 May 2014 Accepted 15 May 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was designed to compare the outcomes in idiopathic epiretinal membrane (ERM) surgery according to sol-vents of indocyanine green (ICG) for internal limiting membrane (ILM) peeling.

Methods

The medical records of 27 patients (27 eyes) with idiopathic ERM who had undergone pars plana vitrectomy with ICG staining for ILM peeling were retrospectively reviewed. The patients were divided into two groups according to solvents of 0.25% ICG solutions. Solvents used were balanced salt solution (BSS) in group I (15 eyes) and 5% glucose in group II (12 eyes). The severity of ERM, the duration of symptoms, the preoperative and postoperative best corrected visual acuity (BCVA) values, the visibility of the stained ILM (Good, Fair, Poor), and the postoperative complications were compared in the two groups.

Results

There was no statistically significant difference in the severity of ERM, the duration of symptoms and the preoperative BCVA in the two groups. The postoperative BCVA was significantly improved in both groups, and the difference was not statisti-cally significant (p = 0.675). There was a significantly smaller number of eyes with poor ILM staining in group II than in group I (p = 0.014). No complications such as recurrence of ERM, atrophy of the retinal pigment epithelium (RPE) or retinal detachment were observed in the two groups.

Conclusions

The higher specific gravity of 5% glucose compared with that of BSS as ICG solvents allows for improved ILM visualization. Therefore using the 5% glucose-ICG solution for staining ILM improved the visibility of ILM compared BSS-ICG solution and led to comparable visual recovery.

Keywords: Epiretinal membrane, Glucose solution, Indocyanine green, Internal limiting membrane, Solvent

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Figure 1.

Surgeon's view. Visual quality of the stained internal limiting membrane (ILM). (A) Good stain. (B) Fair stain. (C) Poor stain.

Figure 2.

Changes in best corrected visual acuity (BCVA) be-tween preoperation (Preop) and postoperation (Postop).

Table 1.

Comparison of patients’ demographics between two groups

	Group I^*	Group II^†	Total	p-value
No. of eyes	15	12	27
Age (years)	63.7 ± 6.0	66.0 ± 6.8	64.7 ± 6.3	0.464^‡
Sex (M:F)	9:6	4:8	13:14	0.168^§
Periods of Sx (months)	16.4 ± 23.7	11.2 ± 14.0	13.9 ± 19.4	0.496^‡
Baseline BCVA (log MAR)	0.55 ± 0.26	0.40 ± 0.22	0.49 ± 0.25	0.172^‡
Lens state (phakic:pseudophakic)	15:0	10:2	25:2	0.188^§
Phacovitrectomy:Vitrectomy	14:1	10:2	24:3	0.569^§
ERM stage (%)				1.000^§
Stage 1	7 (46.7)	5 (41.7)	12 (44.4)
Stage 2	7 (46.7)	6 (50.0)	13 (48.1)
Stage 3	1 (6.7)	1 (8.3)	2 (7.4)

Values are presented as mean ± SD.

BCVA = best corrected visual acuity; ERM = epiretinal membrane; Sx: symptom.

^* Using balanced salt solution (BSS) as solvent of indocyanine green;

^† Using 5% glucose solution as solvent of indocyanine green;

^‡ Mann-Whitney U-test;

^§ Fisher's exact test.

Table 2.

Visualization of internal limiting membrane and number of indocyanine green (ICG) injection with different solvents

	No. of eyes (%)			p-value
	Group I^*	Group II^†	Total	p-value
Visualization of ILM (%)				0.014^‡
Poor	7 (46.7)	1 (8.3)	8 (29.6)
Fair	6 (40.0)	3 (25.0)	9 (33.3)
Good	2 (6.7)	8 (66.7)	10 (37.0)
No. of ICG injections	1.2 ± 0.4	1.1 ± 0.3	1.2 ± 0.4	0.405^§

Values are presented as mean ± SD.

ILM = internal limiting membrane.

^* Using balanced salt solution (BSS) as solvent of indocyanine green;

^† Using 5% glucose solution as solvent of indocyanine green;

^‡ Fisher's exact test;

^§ Mann-Whitney U-test.

Table 3.

Comparison of the anatomical and functional success after surgery between two groups

	No. of eyes (%)		p-value^‡
	Group I^*	Group II^†	p-value^‡
Anatomical success
Complete ILM removal	15 (100.0)	12 (100.0)	1.000
Remained retinal wrinkling	10 (66.7)	4 (33.3)	0.085
Foveal contour	5 (33.3)	9 (75.0)	0.031
Functional success^§	10 (66.7)	8 (66.7)	1.000

ILM = internal limiting membrane.

^* Using balanced salt solution (BSS) as solvent of indocyanine green;

^† Using 5 % glucose solution as solvent of indocyanine green;

^‡ Chi-square test;

^§ Improvement visual acuity more than 2 lines.

Table 4.

Comparison of the BCVA (log MAR) changes after surgery between two groups

BCVA (log MAR)	Group I^*	Group II^†	p-value^‡
Baseline	0.55 ± 0.26	0.40 ± 0.22	0.172
Postoperative 6 months	0.26 ± 0.26	0.20 ± 0.17	0.675
Changes	0.29 ± 0.28	0.20 ± 0.25	0.478
p-value^§	0.004	0.029

Values are presented as mean ± SD.

BCVA = best corrected visual acuity.

^* Using balanced salt solution (BSS) as solvent of indocyanine green;

^† Using 5% glucose solution as solvent of indocyanine green;

^‡ Mann-Whitney U-test;

^§ Wilcoxon signed rank test.

Table 5.

Measurement in osmolality, pH and specific gravity of two solutions

ICG solution	mOsm/kg	pH	Specific gravity
BSS-ICG	272	7.643	1.094
5% glucose-ICG	256	6.999	1.140

ICG = indocyanine green; BSS = balanced salt solution.

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