Prospective study of surgical outcomes and bleb morphology using indocyanine green as a surgical dye in trabeculectomy with mitomycin C

• Published in: Clinical & experimental ophthalmology Vol. 40; no. 4; pp. e143 - e148
• Main Authors: Chan, Kenneth CY, Ang, Ghee S, Birchall, Wayne, Wong, Tracey, Wakely, Laura, Reeves, Graham MB, Small, Keith M, Wells, Anthony P
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.05.2012; Wiley Subscription Services, Inc
• Subjects: Aged; Alkylating Agents - administration & dosage; case series; Coloring Agents; Combined Modality Therapy; Conjunctiva - pathology; Female; Glaucoma - physiopathology; Glaucoma - surgery; Humans; Indocyanine Green; Intraocular Pressure - physiology; Male; Mitomycin - administration & dosage; mitomycin C; Prospective Studies; Sclera - drug effects; Surgically-Created Structures - pathology; Tenon Capsule - drug effects; Trabeculectomy; Treatment Outcome; Visual Acuity - physiology
• ISSN: 1442-6404; 1442-9071
• DOI: 10.1111/j.1442-9071.2011.02589.x

Background:  To investigate the effect of adding indocyanine green to mitomycin C in augmented trabeculectomy. Design:  A prospective, non‐comparative interventional case series. Participants:  A total of 37 eyes of 37 patients followed up for 1 year. Methods:  A solution containing 12.5 mg/mL of indocyanine green was added to mitomycin C, resulting in an mitomycin C concentration of 0.2–0.4 mg/mL, which was applied to bare sclera and Tenon's capsule for 3 min during trabeculectomy. Main Outcome Measures:  Visual acuity, intraocular pressure, bleb morphology, Moorfields Bleb Grading System scores and complications. Results:  Indocyanine green could be visualized on clinical examination for all eyes on the first postoperative day. Mean intraocular pressure decreased from 22.9 ± 6.2 mmHg to 12.1 ± 4.4 mmHg postoperatively (P < 0.001) at 1 year. Thirty‐four eyes (91.9%) achieved an intraocular pressure of less than 21 mmHg at final visit without additional topical intraocular pressure‐lowering medications. Three eyes (8.1%) developed bleb failure andrequired Baerveldt device implantation. There were no cases of blebitis or late bleb leak. No adverse effects attributable to indocyanine green could be identified postoperatively. Conclusion:  The addition of indocyanine green during trabeculectomy improves the visibility of antimetabolites intraoperatively and allows for the estimation of antimetabolite treatment area intraoperatively and postoperatively. It appears to have no adverse effect on surgical outcomes and complication rates, while improving safety of antimetabolite use.