Abstract

SA.19.05

Faster visual rehabilitation after protection of the macular hole with a viscoelastic material during indocyanine green-assisted vitrectomy

Schüler A., Lucke K., Bopp S.
Augenklinik Universitätsallee, Bremen

Objective: This retrospective case control study analyzed the anatomic and visual outcome after indocyanine green (ICG) assisted vitrectomy for macular hole. To prevent ICG-toxicity, a surgical technique was used, in which the area of the macular hole was covered by a viscoelastic material that prevents the staining of the fovea. Surgeries with or without this protection of the macular hole were compared regarding the postoperative anatomical success rate and the postoperative visual acuity.
Methods: 608 phacic eyes, treated between February 2000 and October 2006, were included. All eyes were treated with phacoemulsification and implantation of an intraocular lens in combination with a vitrectomy with an ICG-assisted ILM-peeling and intraocular gas-tamponade (SF₆: 11%; C₂F₆: 81%; C₃F₈: 8%). The mean age was 67.9 years (standard deviation (SD): 6.6 years). 74% had stage 3 macular holes and 24% had stage 4 macular holes. The mean preoperative logMAR visual acuity was 0,74 (SD: 0.29). The mean follow-up was 6.6 months (SD: 9.9 months).
Results: An intraoperative tamponade to protect the macular hole against the effect of ICG was used in 267 eyes (44%). A conventional ICG-assisted ILM-peeling was performed in 341 eyes (56%). The age of the patients (p=0.13), preoperative visual acuity (p=0.31), the frequency of stage 3 or stage 4 macular holes (p=0.13) and the anatomical success rates were similar in both groups (96.4% versus 95.8%, p=0.71). The postoperative increase of the LogMAR-visual acuity 6 weeks after surgery was in the group with tamponade of the macular hole -0.27 (SD: 0.29) and -0.18 (SD: 0.3; p<0,001) in the group with conventional staining of the ILM. The mean follow-up after surgery was 4.7 months (SD 7.9 months) in the tamponade group respectively 8.3 months (SD: 11.4months) in the standard treatment group. During the last examination showed the final increase of the LogMAR-visual acuity no significant difference (-0.3, SD: 0.29 respectively -0.26, SD: 0.37, p=0.35).
Conclusions: The results suggest a short-term indocyanine green toxicity during conventional macular hole repair. The intraoperative protection of the hole with a viscoelastic material might prevent this effect.

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