Functional outcome of indocyanine green-assisted macular surgery: 7-year follow-up

Retina. 2009 Oct;29(9):1249-56. doi: 10.1097/IAE.0b013e3181a91dd3.


Purpose: To evaluate the long-term functional results after surgery for macular pucker and macular holes with indocyanine green (ICG) staining of the internal limiting membrane.

Methods: Long-term functional and anatomical outcomes of 16 eyes of 16 patients were evaluated for 7.3 years after ICG-assisted macular surgery. Examinations performed included best-corrected visual acuity, Goldmann perimetry, Arden color contrast test, optical coherence tomography, and fundus photography. Ten eyes had undergone surgery for macular holes, and 6 eyes had been treated for macular pucker. Indocyanine green with a concentration of 0.05% and an osmolarity of 275 mOsm had been used to stain the internal limiting membrane.

Results: Mean follow-up time was 7.3 years. Eighty-eight percent (14) of the eyes had undergone cataract surgery either in a combined intervention primarily (n = 3) or in the years after the ICG-assisted macular surgery (n = 11). One patient was still phakic with a pronounced cataract at last follow-up. Over all patients, best-corrected visual acuity did not increase significantly from 20/200 (median) before macular surgery to the present 20/70 (median). Large visual field defects (VFDs) were found in 10 of 16 patients after internal limiting membrane staining using ICG. In 8 of these 10 eyes, the VFDs had been diagnosed immediately after vitrectomy and remained unchanged throughout the period of review. In 2 eyes, a VFD was noted at the last follow-up visit despite an unremarkable Goldmann perimetry performed at follow-up visits after 3 months and 6 months. Pathologic color testing was found in 15 of 16 patients when comparing the operated and the fellow eye. A nonglaucomatous optic nerve atrophy was found in 11 of 16 eyes. The optical coherence tomography revealed macular hole closure in all 10 patients.

Conclusion: Indocyanine green-assisted macular surgery might lead to optic nerve atrophy in the long-term and persistent VFDs. In addition, new VFDs may occur in the postoperative course. An affection of color vision also underlines the potential impact of ICG on visual function. A long-term observation of patients after ICG-assisted vitrectomy seems mandatory to reliably detect functional adverse events.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Basement Membrane / pathology
  • Color Perception / physiology*
  • Coloring Agents*
  • Epiretinal Membrane / diagnosis
  • Epiretinal Membrane / physiopathology
  • Epiretinal Membrane / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Indocyanine Green*
  • Male
  • Middle Aged
  • Retinal Perforations / diagnosis
  • Retinal Perforations / physiopathology
  • Retinal Perforations / surgery*
  • Retrospective Studies
  • Staining and Labeling
  • Tomography, Optical Coherence
  • Treatment Outcome
  • Visual Acuity / physiology*
  • Visual Field Tests
  • Visual Fields / physiology*
  • Vitrectomy


  • Coloring Agents
  • Indocyanine Green