Surgical effects and complications of indocyanine green-assisted internal limiting membrane peeling for idiopathic macular hole

Purpose: To compare the surgical outcomes and complications of vitrectomy with internal limiting membrane (ILM) peeling with or without indocyanine green (ICG) staining in eyes with an idiopathic macular hole. Methods: This study involved a non-randomized, single-centre, retrospective, interventional case series. Rates of anatomical closure, visual acuities (VAs) and postoperative complications in 35 eyes of 31 patients who underwent ICG-assisted ILM peeling during macular hole surgery (stained group) were compared with those in 18 eyes of 16 patients who underwent the same procedure without ICG staining (non-stained group). Results: Macular holes were closed following the initial surgery in 97% of the stained group and 94% of the non-stained group (p > 0.999). There was no significant difference in mean final VA between the stained and non-stained groups, but there was a lower percentage of eyes with postoperative vision > 20/25 in the stained group (15%) than in the non-stained group (44%) after 2 years (p = 0.036). Posterior retinal pigment epithelium atrophy, retinoschisis and visual field defects were observed only in the stained group. Conclusions: The difference in mean final VA between the two groups was not significant. However, a lower percentage of eyes obtained VA ≥ 20/25 and a higher incidence of postoperative complications occurred in the stained group. These results indicate that some consideration should be made before ICG is used in macular hole surgery.