Indocyanine green staining and removal of internal limiting membrane in macular hole surgery: histology and outcome

• Published in: American journal of ophthalmology Vol. 132; no. 2; pp. 178 - 183
• Main Authors: Kwok, Alvin K.H, Li, Winnie W.Y, Pang, C.P, Lai, Timothy Y.Y, Yam, Gary H.F, Chan, Nongnart R, Lam, Dennis S.C
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2001; Elsevier
• Subjects: Actins - metabolism; Adult; Aged; Basement Membrane - metabolism; Basement Membrane - pathology; Biological and medical sciences; Collagen - metabolism; Coloring Agents; Epiretinal Membrane - diagnosis; Epiretinal Membrane - metabolism; Epiretinal Membrane - surgery; Female; Glial Fibrillary Acidic Protein - metabolism; Humans; Immunoenzyme Techniques; Indocyanine Green; Male; Medical sciences; Middle Aged; Prospective Studies; Retinal Perforations - diagnosis; Retinal Perforations - metabolism; Retinal Perforations - surgery; Staining and Labeling - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the eye and orbit; Treatment Outcome; Vimentin - metabolism; Visual Acuity; Vitrectomy; Human; Pars plana; Retinopathy; Prognosis; Epiretinal membrane; Maculopathy; Indocyanine green; Internal membrane; Eye; Eye disease; Macular hole; Histopathology; Treatment; Exeresis; Surgery; Vitrectomy; Surgical approach; Technique; Coloration
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/S0002-9394(01)00976-X

PURPOSE: To report the surgical technique, outcome, and histologic findings involving indocyanine green staining and removal of internal limiting membrane in primary macular hole surgery. METHODS: Prospectively, consecutive patients with idiopathic macular hole or myopic macular hole with retinal detachment were recruited. After pars plana vitrectomy and epiretinal membrane removal, the internal limiting membrane was stained and removed. The specimens were stained using hematoxylin and eosin and periodic acid-Schiff. Immunohistochemical staining was also performed for glial fibrillary acidic protein, vimentin, type I and type IV collagen, and actin. RESULTS: Among 10 patients (10 eyes) in the study, nine eyes had stage 3 or 4 macular hole. Four of them had chronic macular hole. The tenth patient had retinal detachment resulting from a myopic macular hole. Postoperatively, all cases had closure of macular hole without an elevated edge and the retina was attached. Seven patients had improvement of 2 or more Snellen lines, whereas visual acuity remained the same for the other three patients. In six eyes in which complete histologic examinations were feasible, internal limiting membrane was confirmed and two eyes also had a small amount of epiretinal membrane. Myofibrocytes in internal limiting membrane, either scattered or as a single layer, were found in three cases. CONCLUSIONS: Removal of indocyanine green-stained internal limiting membrane around idiopathic macular hole or myopic macular hole with retinal detachment is confirmed with histology and may contribute to macular hole closure and retinal reattachment.