Clinical Outcomes of Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane in Epiretinal Membrane Surgery

Woo Seok Choi; Woo Jin Jeong; Yoon Hyung Kwon

doi:10.3341/jkos.2016.57.3.445

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Choi, Jeong, and Kwon: Clinical Outcomes of Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane in Epiretinal Membrane Surgery

Original Article

J Korean Ophthalmol Soc 2016;57(3):445-452.

Published online: 3 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.3.445

Clinical Outcomes of Indocyanine Green-Assisted Peeling of the Internal Limiting Membrane in Epiretinal Membrane Surgery

Woo Seok Choi, MD, Woo Jin Jeong, MD, PhD, Yoon Hyung Kwon, MD

Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea

Address reprint requests to Yoon Hyung Kwon, MD, Department of Ophthalmology, Dong-A University Hospital, #26 Daesingongwon-ro, Seo-gu, Busan 49201, Korea, Tel: 82-51-240-2776, Fax: 82-51-254-1987, E-mail: yhkwon@dau.ac.kr

Received 5 June 2015 Revised 11 October 2015 Accepted 14 January 2016

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

In this study we compared the clinical outcomes of idiopathic epiretinal membrane (ERM) surgery according to the use of indocyanine green (ICG) and ICG exposure time.

Methods

The medical records of 76 patients with an idiopathic ERM that underwent vitrectomy and ERM and internal limiting membrane (ILM) removal were reviewed. We compared the results (best corrected visual acuity [BCVA, log MAR] and central macular thickness [CMT, μm]) of idiopathic ERM surgeries using ILM peeling with (group I, 39 eyes) and without ICG (group II, 37 eyes). Additionally, the correlation of ICG exposure time and clinical outcomes in group I was analyzed.

Results

Gender, age, lens state, preoperative BCVA, and preoperative CMT were not significantly different between the two groups. The postoperative BCVA was significantly improved in both groups but the difference was not statistically significant. The postoperative CMT was significantly improved in both groups and the change amount of group I was more larger than group II. Additionally, ICG exposure time was not significantly correlated with changes of BCVA and CMT.

Conclusions

Intravitreal ICG-assisted ILM peeling did not significantly affect the recovery of BCVA, however that impaired the recovery of CMT. ICG exposure time did not affect the postoperative visual outcome.

Keywords: Exposure time, Idiopathic epiretinal membrane, Indocyanine green, Internal limiting membrane

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Figure 1.

Comparison of the change amount of BCVA (log MAR) and the CMT (μm) in the two groups. (A) The change amount of BCVA (log MAR) did not differ significantly between the two groups at any point. (B) The change amount of CMT (μm) in the ‘ICG dye with triamcinolone’ group was significantly smaller than that in the ‘triamcinolone only’ group at 3 months after surgery (p = 0.042, ^*Student t-test). BCVA = best corrected visual acuity; CMT = central macular thickness; Post op. = postoperative; ICG = indocyanine green.

Figure 2.

Scatter plots of ICG exposure time versus BCVA change and CMT change of 3 months value after operation. (A) ICG exposure time is not significantly correlated with BCVA change (r^* = −0.55, p = 0.74). (B) ICG exposure time is not significantly correlated with CMT change (r^* = −0.312, p = 0.71). ICG = indocyanine green; BCVA = best corrected visual acuity; CMT = central macular thickness. ^*Pearson's correlation test.

Table 1.

Comparison of patient's demographics between the two groups

	Group I^* (39 eyes)	Group II^† (37 eyes)	p-value
Age (years)	66.23 ± 9.48 (44-92)	68.18 ± 8.79 (47-83)	0.692^‡
Male:female	18:21	16:21	0.721^§
Phakia:pseudophakia	31:8	29:8	0.953^§
Preop BCVA (log MAR)	0.55 ± 0.22	0.61 ± 0.22	0.223^†
Preop CMT (μm)	419.69 ± 79.66	392.71 ± 109.25	0.219^‡
Total ICG exposure time (seconds)	37.74 ± 15.09 (14-74)	(-)	(-)
Numbers of ICG injection	2.33 ± 0.83 (1-4)	(-)	(-)

Values are presented as mean ± SD unless otherwise indicated.

Preop = preoperative; BCVA = best corrected visual acuity; CMT = central macular thickness; ICG = indocyanine green.

^* Using triamcinolone with indocyanine green to stain the internal limiting membrane;

^† Using only triamcinolone;

^‡ Student t-test;

^§ Chi-square test.

Table 2.

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

BCVA (log MAR)	Baseline	Postoperative 1 week	Postoperative 1 month	Postoperative 3 months	p-value^‡
Group I^*					0.003
BCVA	0.55 ± 0.22	0.66 ± 0.37	0.51 ± 0.34	0.36 ± 0.36
Δ	−	−0.08 ± 0.30	0.03 ± 0.28	0.20 ± 0.31
Group II^†					<0.001
BCVA	0.61 ± 0.22	0.79 ± 0.32	0.56 ± 0.24	0.48 ± 0.31
Δ	−	−0.16 ± 0.33	0.04 ± 0.25	0.13 ± 0.25
p-value^§	−	0.254	0.898	0.318

Values are presented as mean ± SD unless otherwise indicated.

BCVA = best corrected visual acuity; Δ = baseline value-postoperative value.

^* Using triamcinolone with indocyanine green to stain the internal limiting membrane;

^† Using only triamcinolone;

^‡ Compared to baseline with the value of postoperative 3 months, paired t-test;

^§ Comparison of the BCVA change amount between the two groups at each point, Student t-test.

Table 3.

Comparison of the CMT (μm) changes after surgery between the two groups

CMT (μm)	Baseline	Postoperative 1 week	Postoperative 1 months	Postoperative 3 months	p-value^‡
Group I^*
CMT (μm)	419.69 ± 79.66	402.36 ± 64.52	386.45 ± 62.16	372.71 ± 51.34	<0.001
Δ	−	10.47 ± 15.70	45.94 ± 87.37	46.84 ± 63.32
Group II^†
CMT (μm)	392.71 ± 109.25	357.26 ± 78.29	342.18 ± 73.66	336.97 ± 72.48	<0.001
Δ	−	38.82 ± 79.67	53.69 ± 84.70	86.18 ± 84.04
p-value^§	−	0.059	0.70	0.042

Values are presented as mean ± SD unless otherwise indicated.

CMT = central macular thickness; Δ = baseline value-postoperative value.

^* Using triamcinolone with indocyanine green to stain the internal limiting membrane;

^† Using only triamcinolone;

^‡ Compared to baseline with the value of postoperative 3 months, paired t-test;

^§ Comparison of the CMT change amount between the two groups at each point, Student t-test.

Table 4.

Correlation of ICG exposure time with best corrected visual acuity and central macular thickness changes

ICG time	ΔBCVA			ΔCMT
ICG time	1 week	1 month	3 months	1 week	1 month	3 months
Pearson coefficients (r)^*	−0.312	−0.3	−0.55	−0.245	−0.062	−0.312
p-value^*	0.053	0.86	0.74	0.139	0.341	0.71

ICG = indocyanine green; BCVA = best corrected visual acuity; CMT = central macular thickness; Δ = baseline value-postoperative value.

^* Pearson's correlation test.

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