Indocyanine green-assisted internal limiting membrane peeling for macular holes: toxicity?

Retina. 2006 Jul-Aug;26(6):637-44. doi: 10.1097/00006982-200607000-00008.


Background: Indocyanine green (ICG) staining facilitates definitive internal limiting membrane (ILM) peeling during macular hole surgery (MHS), but might cause toxicity.

Purpose: To determine if ICG to assist in ILM peeling has an effect on anatomic or visual results in MHS with ILM peeling.

Methods: Retrospective, comparative review including primary analysis of 173 cases undergoing MHS. Visual acuity >or=20/50, <or=20/200, three-line visual acuity improvement, and anatomic success rates were analyzed as endpoints.

Results: The single operation hole closure rate was 87% with ICG versus 83% without ICG (P = 0.52). Postoperative median best-corrected visual acuity was 20/70 and 20/80 in the ICG and no ICG groups with median follow-up intervals of 8 and 9 months. The use of ICG was associated with a higher rate of <or=20/200, but ILM peeling and ICG use was not associated with better anatomic success, visual improvement, or >or=20/50 visual acuity.

Conclusions: ICG usage during macular hole surgery was not associated with worse visual outcomes, suggesting possible toxic effects reported are not clinically significant. If the ILM cannot be peeled effectively, ICG should be considered a safe option.

MeSH terms

  • Aged
  • Basement Membrane / pathology
  • Basement Membrane / surgery
  • Coloring Agents* / adverse effects
  • Epiretinal Membrane / diagnosis
  • Epiretinal Membrane / physiopathology
  • Epiretinal Membrane / surgery*
  • Female
  • Humans
  • Indocyanine Green* / adverse effects
  • Injections
  • Male
  • Multivariate Analysis
  • Retina / drug effects
  • Retina / physiopathology
  • Retinal Perforations / diagnosis
  • Retinal Perforations / physiopathology
  • Retinal Perforations / surgery*
  • Retrospective Studies
  • Staining and Labeling / methods
  • Visual Acuity / drug effects
  • Visual Acuity / physiology
  • Vitrectomy
  • Vitreous Body / drug effects


  • Coloring Agents
  • Indocyanine Green