Idiopathic Macular Hole Surgery With Low-Concentration Infracyanine Green-Assisted Peeling of the Internal Limiting Membrane

Lanzetta, Paolo; Polito, Antonio; Del Borrello, Michele; Narayanan, Raja; Shah, Vinay A.; Frattolillo, Antonio; Bandello, Francesco

doi:10.1016/j.ajo.2006.06.032

« Previous Next »American Journal of Ophthalmology
Volume 142, Issue 5 , Pages 771-776.e2, November 2006

Idiopathic Macular Hole Surgery With Low-Concentration Infracyanine Green-Assisted Peeling of the Internal Limiting Membrane

Paolo Lanzetta, MD
- Department of Ophthalmology, University of Udine, Udine, Italy
- Inquiries to Paolo Lanzetta, MD, University of Udine, Department of Ophthalmology, Piazzale S. Maria della Misericordia, 33100 Udine, Italy
Antonio Polito, MD
- Department of Ophthalmology, University of Udine, Udine, Italy
Michele Del Borrello, MD
- Department of Ophthalmology, University of Udine, Udine, Italy
Raja Narayanan, MD
- L. V. Prasad Eye Institute, Hyderabad, India
Vinay A. Shah, MD
- Department of Ophthalmology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Antonio Frattolillo, MD
- Department of Ophthalmology, University of Udine, Udine, Italy
Francesco Bandello, MD
- Department of Ophthalmology, University of Udine, Udine, Italy

Accepted 6 June 2006. published online 25 July 2006.

Purpose

To evaluate the efficacy of pars plana vitrectomy with infracyanine green (IFCG)-assisted internal limiting membrane peeling for the treatment of idiopathic macular hole.

Design

Prospective, noncomparative interventional case series.

Methods

Thirty-eight consecutive eyes of 35 patients with idiopathic macular hole were included in the study. Patients underwent early treatment diabetic retinopathy (ETDRS) visual acuity examination, dilated ophthalmoscopy, and optical coherence tomography before treatment and during follow-up. Fluorescein angiography was done in selected cases. Patients underwent a three-port pars plana vitrectomy with complete posterior hyaloid and epiretinal membrane removal. The internal limiting membrane (ILM) was stained with 0.5 cc of IFCG (0.5 mg/ml, 308 mOsm) and peeled up to the vascular arcades. Perfluoropropane gas (C₃F₈) 10% was used as tamponade.

Results

Mean follow-up duration was 10 ± 5 months (range, 3 to 24 months). Six eyes had stage 2 macular hole, 15 eyes stage 3, and 16 eyes stage 4. Overall, 37 of 38 macular holes closed after a single surgery. Median visual acuity was 20/100 (range, 20/400 to 20/50) before surgery and 20/50 (range, 20/640 to 20/25) after surgery. Visual acuity after surgery was 20/50 or better in 24 of 38 (63.1%) eyes. Twenty-five (65.8%) eyes improved by 2 or more lines, nine (23.7%) eyes were stable, and four (10.5%) eyes worsened by 2 or more lines.

Conclusions

This study suggests that IFCG (0.05%) effectively stains the ILM with apparent safety, and that IFCG-assisted peeling of the ILM may be useful in the treatment of idiopathic macular hole.