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Implications for Macular Hole Surgery

Jau-Der Ho, MD; Ray Jui-Fang Tsai, MD; San-Ni Chen, MD; Hung-Chiao Chen, MD

Arch Ophthalmol. 2003;121:1423-1429.

Objective  To evaluate the potential cytotoxic effects of indocyanine green (ICG) on cultured human retinal pigment epithelium (RPE) and the resultant implications for macular hole surgery.

Methods  Human RPE cells were exposed to ICG in concentrations from 0.001 to 5 mg/mL. The exposure duration ranged from 5 minutes to 3 hours. Light microscopy, MTS viability assay, and calcein AM–ethidium homodimer 1 staining were used to evaluate the cytotoxic effects of ICG.

Results  The RPE cells incubated with up to 5 mg/mL of ICG for 5 minutes or less exhibited no morphologic change and no significant decrease in dehydrogenase activity. When RPE cells were exposed to 5 mg/mL of ICG for 10 minutes, 1 mg/mL of ICG for 20 minutes, or 0.01 mg/mL of ICG for 3 hours, cell morphologic features were altered, mitochondrial dehydrogenase activity decreased, and some cells were necrotic.

Conclusions  Indocyanine green caused cytotoxicity in cultured human RPE in a dose- and time-dependent manner. Cell death occurred by necrosis.

Clinical Relevance  Exposure of RPE cells to ICG concentrations up to 5 mg/mL for 5 minutes or less was not injurious; prolonged exposure to a low ICG concentration was toxic. Since ICG may be retained in the vitreous cavity for a lengthy period, thorough washout of ICG during macular hole surgery is required.

From the Department of Ophthalmology, Chang Gung Memorial Hospital, Kuei-Shan, Taoyuan, Taiwan. The authors have no relevant financial interest in this article.

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