Clinical Outcomes of Minimal Exposure to Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane

Hee Young Chung; Gi Sung Sohn; Kyung Min Lee; Duck Jin Hwang; Joon Hong Sohn; Young Sook Park

doi:10.3341/jkos.2015.56.10.1572

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Chung, Sohn, Lee, Hwang, Sohn, and Park: Clinical Outcomes of Minimal Exposure to Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane

Original Article

J Korean Ophthalmol Soc 2015;56(10):1572-1579.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.10.1572

Clinical Outcomes of Minimal Exposure to Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane

Hee Young Chung, M.D, Gi Sung Sohn, M.D, Kyung Min Lee, M.D, Duck Jin Hwang, M.D, Joon Hong Sohn, M.D, Young Sook Park, M.D

Hangil Eye Hospital, Incheon, Korea

Address reprint requests to Young Sook Park, MD Hangil Eye Hospital, #35 Bupyeong-daero, Bupyeong-gu, Incheon 21388, Korea Tel: 82-32-503-3322, Fax: 82-32-503-0801 E-mail: Parkys73@lycos.co.kr

Received 23 January 201529 May 2015 Accepted 14 August 2015

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

To evaluate the clinical outcomes of epiretinal membrane (ERM) surgery with minimal exposure to indocyanine green (ICG) dye-assisted internal limiting membrane (ILM) peeling compared with no ICG dye.

Methods

We divided 33 eyes with ERM treated by vitrectomy into 2 groups. ICG dye was used in the first group of 18 eyes (ICG group) but not in the second group of 15 eyes (no dye [ND] group). In the ICG group, 0.25% diluted ICG dye was injected into the fluid-filled eye and removed with a back-flushing needle after 3-5 seconds to peel ILM. Value changes in several parameters in-cluding visual acuity, central macular thickness, Humphrey automated kinetic perimetric analysis, and peripapillary retinal nerve fiber layer (RNFL) thickness were followed up and compared according to ICG dye use.

Results

No differences were found between the 2 groups in terms of visual acuity, central macular thickness, and peripapillary RNFL thickness preoperatively and at 6 months postoperatively (p = 0.125 for visual acuity, p = 0.734 for central macular thick-ness, p = 0.615 for RNFL thickness). Six months after surgery, no significant increase was found in any region of visual field in the ICG group ( p = 0.392). The visual field was significantly increased in the superior region in the ND group ( p = 0.042). The RNFL thickness in the temporal quadrant was significantly reduced at 6 months postoperatively compared to baseline values in both groups ( p = 0.011 for ICG group, p = 0.042 for ND group).

Conclusions

ICG dye-assisted ILM peeling does not aggravate clinical outcomes of ERM surgery in terms of visual acuity, cen-tral macular thickness, visual fields, or RNFL thickness and can be safely utilized with proper techniques.

Keywords: Epiretinal membrane, Indocyanine green, Visual field

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Figure 1.

Measuring the size of epiretinal membrane with red-free fundus photography and the Photoshop program (Photoshop 5.5, Adobe Systems Inc., San Jose, CA, USA). The selected area (dotted line) is expressed in pixels (red arrow) by the histogram option.

Figure 2.

Changes of visual fields according to regions and study points in the indocyanine green (ICG) group (A), and in the ND group (B). Superior visual fields significantly improved at 6 months after surgery in the ND group. ICG group is indocyanine green dye assisted internal limiting membrane peeling and ND group is internal limiting membrane peeling without staining. ND = no dye; Pre = preoperative period; M = months.

Figure 3.

Changes of preoperative and postoperative total visu-al fields. There was no significant difference between the groups. ICG group is indocyanine green dye assisted internal limiting membrane peeling and ND group is internal limiting membrane peeling without staining. ICG = indocyanine green. ND = no dye; Pre = preoperative period; M = months.

Figure 4.

Changes of nerve fiber layer thickness according to regions and study points in the ICG group (A), and in the ND group (B). It showed that temporal peripapillary RNFL thickness were significantly thinning at 3 months and 6 months in both groups. ICG group is indocyanine green dye assisted internal limiting membrane peeling and ND group is internal limiting membrane peeling without staining. ICG = indocyanine green; ND = no dye; RNFL = retinal nerve fiber layer; Pre = preoperative period; M = months.

Table 1.

Preoperative demographic findings

	Total (n = 33)	ICG group^* (n = 18)	ND group^† (n = 15)	p-value
Age (years)	63.9 (49-74)	63.3 (49-74)	64.5 (55-71)	0.438
Sex (M:F)	10:23	6:12	4:11	0.541
OD:OS	19:14	13:5	6:9	0.094
Preoperative visual acuity (log MAR)	0.46 ± 0.29	0.40 ± 0.34	0.53 ± 0.34	0.263
Preoperative IOP (mm Hg)	14.6 ± 3.2	15.1 ± 2.8	13.9 ± 3.3	0.112
Combined surgery (eyes)	26	17	9	0.017

Values are presented as mean ± SD unless otherwise indicated. ICG = indocyanine green; ND = no dye; M = male; F = female; OD = oculus dexter; OS = oculus sinister; IOP = intraocular pressure.

^* Indocyanine green dye assisted internal limiting membrane peeling;

^† Internal limiting membrane peeling without staining.

Table 2.

Visual acuity changes over time

	Best corrected visual acuity (log MAR)
	Baseline	3 months	6 months
ICG group^*	0.40 ± 0.34	0.20 ± 0.26	0.15 ± 0.50
p-value^†	-	0.003	0.001
ND group^‡	0.53 ± 0.34	0.34 ± 0.26	0.29 ± 0.50
p-value^†	-	0.045	0.038
p-value^§	0.278	0.235	0.125

Values are presented as mean ± SD unless otherwise indicated. ICG = indocyanine green; ND = no dye.

^* Indocyanine green dye assisted internal limiting membrane peeling;

^† Compared to baseline. Wilcoxon’s signed rank test;

^‡ Internal limiting membrane peeling without staining;

^§ Comparison between the two groups at each time point. Mann-Whitney’s U-test.

Table 3.

Central macular thickness changes over time

	Central macular thickness (μ m)
	Baseline	3 months	6 months
ICG group^*	417.1 ± 121.9	369.5 ± 60.6	350.1 ± 66.2
p-value^†	-	0.030	0.009
ND group^‡	458.8 ± 142.7	422.6 ± 49.7	360.6 ± 51.3
p-value^†	-	0.058	0.025
p-value^§	0.395	0.061	0.734

Values are presented as mean ± SD unless otherwise indicated. ICG = indocyanine green; ND = no dye.

^* Indocyanine green dye assisted internal limiting membrane peeling;

^† Compared to baseline. Wilcoxon’s signed rank test;

^‡ Internal limiting membrane peeling without staining;

^§ Comparison between the two groups at each time point. Mann-Whitney’s U-test.

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