Department of Ophthalmology, Affiliated Tenth People's Hospital of Tongji University, Shanghai, China.
PLoS One. 2012;7(11):e48405. doi: 10.1371/journal.pone.0048405. Epub 2012 Nov 7.
The opinion of application of indocyanine green (ICG) in the macular hole surgery was contradictory. Here we conducted a meta-analysis to evaluate the effect of in internal limiting membrane (ILM) peeling for macular hole surgery.
We searched electronic databases for comparative studies published before July 2012 of ILM peeling with and without ICG. Twenty-two studies including 1585 eyes were included. Visual acuity (VA) improvement, including the postoperative rate of ≥20/40 VA gained (OR, 0.65; 95% CI, 0.43 to 0.97; P = 0.033) and increased LogMAR (WMD, -0.09; 95% CI, -0.16 to -0.02; P = 0.011), was less in the ICG group. The risk of visual field defects was greater in the ICG group than in the non-ICG group. There was no significant difference in the rate of anatomical outcomes between ILM peeling procedures performed with and without ICG. RPE changes and other postoperative complications were not significantly different between the ICG and non-ICG groups. An additional analysis showed that the VA improvement of the ICG group was less than the non-ICG group only within the first year of follow up. A subgroup analysis showed that the rate of VA improvement was lower in the ICG group than in other adjuncts group. A higher rate of secondary closure and less VA improvement were observed in a high proportion (>0.1%) of the ICG group. A sensitivity analysis after the randomized-controlled trials were excluded from the meta-analysis demonstrated no differences compared with the overall results.
This meta-analysis demonstrated that there is no evidence of clinical superiority in outcomes for ICG-assisted ILM peeling procedure over the non-ICG one. The toxicity of ICG should be considered when choosing the various staining methods.
吲哚菁绿（ICG）在黄斑裂孔手术中的应用意见不一。本研究进行了荟萃分析，以评估内界膜（ILM）剥除在黄斑裂孔手术中的效果。
我们检索了 2012 年 7 月前发表的关于 ILM 剥除联合与不联合 ICG 的对照研究。共纳入 22 项研究，包含 1585 只眼。视力改善包括术后 ≥20/40 视力提高率（OR，0.65；95%CI，0.43 至 0.97；P=0.033）和 LogMAR 提高（WMD，-0.09；95%CI，-0.16 至 -0.02；P=0.011），ICG 组均较低。ICG 组视野缺损风险高于非 ICG 组。ILM 剥除术中应用与不应用 ICG 对解剖学结果的影响无显著差异。RPE 改变和其他术后并发症在 ICG 组与非 ICG 组之间无显著差异。进一步分析显示，ICG 组的视力改善在随访的第一年小于非 ICG 组。亚组分析显示，ICG 组的视力改善率低于其他辅助组。在 ICG 组中，有较高比例（>0.1%）的患者出现继发性闭合和视力改善较差。排除随机对照试验后进行敏感性分析，与总体结果相比无差异。
本荟萃分析表明，在结果方面，ICG 辅助的 ILM 剥除术并不优于非 ICG 术式。在选择各种染色方法时，应考虑 ICG 的毒性。
