Haritoglou Christos, Gandorfer Arnd, Gass Carolin A, Schaumberger Markus, Ulbig Michael W, Kampik Anselm
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Am J Ophthalmol. 2002 Dec;134(6):836-41. doi: 10.1016/s0002-9394(02)01816-0.
To report the ultrastructure of the internal limiting membrane (ILM) after macular hole surgery with indocyanine green (ICG) staining and to investigate an association with the postoperative functional outcome.
Retrospective, noncomparative analysis of a consecutive case series.
Twenty eyes of 20 patients after macular hole surgery with ICG staining were included. Visual acuity and Goldmann perimetry were obtained before and after surgery. The ILM was obtained during three-port pars plana vitrectomy for idiopathic macular hole. Twenty-five milligrams of sterile ICG powder was dissolved in 5 ml of sterile water as recommended by the manufacturer and then diluted in balanced salt solution. The ultrastructure of the ILM was analyzed using light and transmission electron microscopy. Osmolarity and pH of the ICG solution were measured preoperatively.
There was no statistically significant improvement of postoperative visual acuity after ICG-assisted peeling (P =.755). In seven patients, postoperative visual field defects occurred. Indocyanine green-stained specimens revealed cellular elements resembling the plasma membrane of Müller cells and other undetermined retinal structures adherent to the retinal side of the ILM. Histologic findings disclosed no difference between patients with and without visual field defects after the use of ICG. The osmolarity of the ICG solution applied was 275 mOsm; pH was 7.5.
Intravitreal application of ICG may cause retinal damage by altering the cleavage plane to the innermost retinal layers. That may result in less improvement of visual acuity and unexpected visual field defects. The underlying mechanisms of action remain unclear and are the subject of ongoing investigations.
报告黄斑裂孔手术中使用吲哚菁绿（ICG）染色后内界膜（ILM）的超微结构，并研究其与术后功能结果的相关性。
对连续病例系列进行回顾性、非对照分析。
纳入20例患者的20只眼，这些眼在黄斑裂孔手术后接受了ICG染色。在手术前后测量视力和Goldmann视野。在三通道玻璃体切割术中获取特发性黄斑裂孔患者的ILM。按照制造商的建议，将25毫克无菌ICG粉末溶解在5毫升无菌水中，然后用平衡盐溶液稀释。使用光学显微镜和透射电子显微镜分析ILM的超微结构。术前测量ICG溶液的渗透压和pH值。
ICG辅助剥除术后视力无统计学意义的改善（P = 0.755）。7例患者出现术后视野缺损。吲哚菁绿染色标本显示细胞成分类似于Müller细胞的质膜以及附着在ILM视网膜侧的其他未确定的视网膜结构。组织学结果显示，使用ICG后有视野缺损和无视野缺损的患者之间没有差异。所用ICG溶液的渗透压为275 mOsm；pH值为7.5。
玻璃体内应用ICG可能通过改变至视网膜最内层的分离平面而导致视网膜损伤。这可能导致视力改善较少和意外的视野缺损。潜在的作用机制仍不清楚，是正在进行的研究的主题。
