Department of Ophthalmology, Ludwig-Maximilian-University, Munich, Germany.
Retina. 2009 Oct;29(9):1249-56. doi: 10.1097/IAE.0b013e3181a91dd3.
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.
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.
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.
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.
评估吲哚菁绿（ICG）辅助内界膜染色治疗黄斑皱襞和黄斑裂孔的长期功能结果。
对 16 例（16 只眼）接受 ICG 辅助黄斑手术后 7.3 年的长期功能和解剖结果进行评估。检查包括最佳矫正视力、Goldmann 视野计、Arden 色对比试验、光学相干断层扫描和眼底照相。10 只眼行黄斑裂孔手术，6 只眼行黄斑皱襞治疗。使用浓度为 0.05%、渗透压为 275mOsm 的吲哚菁绿染色内界膜。
平均随访时间为 7.3 年。88%（14 只眼）在接受 ICG 辅助黄斑手术后的最初（n=3）或之后（n=11）行白内障手术。1 例患者最后一次随访时仍为白内障，伴有明显白内障。所有患者的最佳矫正视力均无明显提高，黄斑手术后从 20/200（中位数）提高至 20/70（中位数）。16 例患者中有 10 例在 ICG 染色后出现大视野缺损（VFD）。这 10 只眼中，10 只眼在玻璃体切除术后立即发现 VFD，整个随访期间无变化。2 只眼在 3 个月和 6 个月的随访时行 Goldmann 视野计检查未见异常，但在最后一次随访时发现 VFD。比较患眼和对侧眼，16 例患者中有 15 例行病理性色觉检查发现异常。16 只眼中的 11 只发现非青光眼性视神经萎缩。光学相干断层扫描显示所有 10 例患者黄斑裂孔闭合。
ICG 辅助黄斑手术后可能导致长期视神经萎缩和持续的 VFD。此外，术后可能出现新的 VFD。色觉异常也强调了 ICG 对视功能的潜在影响。ICG 辅助玻璃体切除术后患者的长期观察对于可靠地检测功能不良事件似乎是必要的。
