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Clinical Sciences
October 2004

Visual Field Defects After Intravitreous Administration of IndocyanineGreen in Macular Hole Surgery

Author Affiliations

From the Department of Ophthalmology, Kagoshima City Hospital (DrsKanda, Uemura, Yamashita, and Kita), and the Department of Ophthalmology,Kagoshima University Graduate School of Medicine and Dental Sciences (DrsKanda, Yamashita, Yamakiri, and Sakamoto), Kagoshima, Japan. The authors haveno relevant financial interest in this article.

Arch Ophthalmol. 2004;122(10):1447-1451. doi:10.1001/archopht.122.10.1447

Objectives  To report the findings on a patient cohort with visual field defectsafter macular hole surgery with indocyanine green (ICG)–assisted internallimiting membrane peeling and to investigate the correlation between the defectsand the use of ICG.

Design  Retrospective, noncomparative interventional case series.

Participants  Thirty-nine eyes of 38 patients having the clinical diagnosis of a macularhole who underwent pars plana vitrectomy between January 1, 2001, and December31, 2002, were enrolled in this study.

Intervention  Indocyanine green–assisted internal limiting membrane peelingwas performed on a series of 22 eyes: 12 eyes using a 0.5% ICG solution and3-minute exposure to the retina (group 1), 4 eyes using a 0.5% ICG solutionand immediate washout (group 2), and 6 eyes using a 0.25% ICG solution andimmediate washout (group 3). The remaining 17 eyes underwent vitrectomy withoutICG-assisted internal limiting membrane peeling (group 4).

Main Outcome Measures  Visual field, best-corrected visual acuity, and fundus photography wereevaluated.

Results  Postoperatively, all patients (100%) in group 1 and 1 (25%) of 4 eyesin group 2 had visual field defects. None of the patients in group 3 had avisual field defect. The visual field defects included 10 eyes (84%) withnasal defects, 1 eye (8%) with an inferotemporal defect, and 1 eye (8%) withan extensive visual field defect. Ophthalmoscopy revealed mild to moderateoptic 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 otherpatients in group 4 had visual field defects. There was no statistically significantdifference in postoperative visual acuity between patients with and withoutpostoperative visual field defects.

Conclusions  Although this study was limited by the few patients enrolled, our experienceindicates that visual field defects, specifically nasal defects, can occurafter macular hole surgery with ICG-assisted internal limiting membrane peeling,and that the incidence depends on the concentration of the ICG solution and/orthe exposure time to the retina. Further studies are needed to clarify thepathomechanism of visual field defects.