Long-term follow-up of indocyanine green-assisted peeling of the retinal internal limiting membrane during vitrectomy surgery for idiopathic macular hole repair

Ophthalmology. 2004 Dec;111(12):2246-53. doi: 10.1016/j.ophtha.2004.05.037.


Objective: To determine the long-term efficacy of indocyanine green (ICG)-assisted retinal internal limiting membrane (ILM) peeling during macular hole repair.

Design: Retrospective, interventional, noncomparative case series.

Participants: One hundred twenty-one eyes of 114 patients with stage 2, 3, or 4 idiopathic macular holes that underwent ICG-assisted macular hole repair during the period of August 1999 to January 2003.

Intervention: All eyes underwent a pars plana vitrectomy, including peeling of the posterior cortical hyaloid when necessary. Indocyanine green dye (0.5%) was instilled over the macula, and after removal of the ICG, the retinal ILM was peeled. Medium- to long-acting gas tamponade was used in all cases, and all patients were asked to position themselves facedown for 1 to 2 weeks.

Main outcome measures: Long-term postoperative anatomic results, visual acuity (VA), and complications.

Results: Patients were observed postoperatively for an average of 26 months (range, 12-53). Anatomic closure of the macular hole was achieved in 118 eyes (98%) with a single surgery. Reoperation was successful at closing 2 of the 3 macular holes that did not close initially. One macular hole reopened 16 months after the original surgery, and the patient has not yet undergone further surgery. Visual acuity improved by > or =2 lines in 116 eyes (96%). Mean visual improvement after surgery was 6 lines (range, 0-14), and 96 eyes (79%) achieved a final VA of 20/50 or better. There were no intraoperative or postoperative complications attributed to the use of ICG.

Conclusions: Long-term follow-up of patients who underwent ICG-assisted ILM peeling for idiopathic macular hole repair demonstrates excellent anatomic and visual results.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Basement Membrane / pathology
  • Basement Membrane / surgery
  • Coloring Agents*
  • Epiretinal Membrane / diagnosis
  • Epiretinal Membrane / surgery*
  • Fluorescein Angiography
  • Follow-Up Studies
  • Humans
  • Indocyanine Green*
  • Intraoperative Care
  • Intraoperative Complications
  • Lens Implantation, Intraocular
  • Middle Aged
  • Phacoemulsification
  • Postoperative Complications
  • Retinal Perforations / diagnosis
  • Retinal Perforations / surgery*
  • Retrospective Studies
  • Treatment Outcome
  • Visual Acuity
  • Vitrectomy / methods*


  • Coloring Agents
  • Indocyanine Green