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Visual Field Defects After Intravitreous Administration of Indocyanine Green in Macular Hole Surgery
Shigeru Kanda, MD;
Akinori Uemura, MD;
Takehiro Yamashita, MD;
Hazuki Kita, MD;
Keita Yamakiri, MD;
Taiji Sakamoto, MD
Arch Ophthalmol. 2004;122:1447-1451.
Objectives To report the findings on a patient cohort with visual field defects after macular hole surgery with indocyanine green (ICG)–assisted internal limiting membrane peeling and to investigate the correlation between the defects and the use of ICG.
Design Retrospective, noncomparative interventional case series.
Participants Thirty-nine eyes of 38 patients having the clinical diagnosis of a macular hole who underwent pars plana vitrectomy between January 1, 2001, and December 31, 2002, were enrolled in this study.
Intervention Indocyanine green–assisted internal limiting membrane peeling was performed on a series of 22 eyes: 12 eyes using a 0.5% ICG solution and 3-minute exposure to the retina (group 1), 4 eyes using a 0.5% ICG solution and immediate washout (group 2), and 6 eyes using a 0.25% ICG solution and immediate washout (group 3). The remaining 17 eyes underwent vitrectomy without ICG-assisted internal limiting membrane peeling (group 4).
Main Outcome Measures Visual field, best-corrected visual acuity, and fundus photography were evaluated.
Results Postoperatively, all patients (100%) in group 1 and 1 (25%) of 4 eyes in group 2 had visual field defects. None of the patients in group 3 had a visual field defect. The visual field defects included 10 eyes (84%) with nasal defects, 1 eye (8%) with an inferotemporal defect, and 1 eye (8%) with an extensive visual field defect. Ophthalmoscopy revealed mild to moderate optic disc pallor in 8 (62%) of 13 eyes with postoperative visual field defects. Only 1 patient in group 4 had an inferotemporal defect; none of the other patients in group 4 had visual field defects. There was no statistically significant difference in postoperative visual acuity between patients with and without postoperative visual field defects.
Conclusions Although this study was limited by the few patients enrolled, our experience indicates that visual field defects, specifically nasal defects, can occur after macular hole surgery with ICG-assisted internal limiting membrane peeling, and that the incidence depends on the concentration of the ICG solution and/or the exposure time to the retina. Further studies are needed to clarify the pathomechanism of visual field defects.
From the Department of Ophthalmology, Kagoshima City Hospital (Drs Kanda, Uemura, Yamashita, and Kita), and the Department of Ophthalmology, Kagoshima University Graduate School of Medicine and Dental Sciences (Drs Kanda, Yamashita, Yamakiri, and Sakamoto), Kagoshima, Japan. The authors have no relevant financial interest in this article.
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