[原著］Atrophic changes in the retinal pigment epithelium after macular hole surgery using an indocyanine green dye

概要

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Since indocyanine green (ICG) dye was introduced for macular hole (MH) surgery to facilitate visualization of the internal limiting membrane (ILM), successful anatomic closure of MHs has been achieved in almost all cases. However, when only using ICG dye is used atrophic changes of the retinal pigment epithelium (RPE) sometimes occur in the area of the previous MH. There is a possibility that these atrophic changes might be due to the toxicity of the ICG dye. Here we report 2 cases with such atrophic RPE changes after surgery using ICG dye. Moreover, for the first time, we observed the auto fluorescence of ICG over time and found that ICG remained in the macular area longer than expected. The similarity between the present 2 cases was that their preoperative visual acuities were less than 20/200. These findings suggest that the RPE cells might be exposed to the ICG dye for a long time and be more affected by the toxicity of ICG the previously thought. Since RPE cells in cases of poor visual acuities become fragile, they might be more susceptive to the toxicity of ICG. We conclude that sufficient care should be taken when ICG is used for MH cases with poor visual acuities.
琉球医学会の論文