COMMENTARY

Visual Function After Macular Hole Surgery

Hemang K. Pandya, MD; Sophie J. Bakri, MD

Disclosures

June 14, 2013

Comparison of Vitrectomy With Brilliant Blue G or Indocyanine Green on Retinal Microstructure and Function of Eyes With Macular Hole

Baba T, Hagiwara A, Sato E, Arai M, Oshitari T, Yamamoto S
Ophthalmology. 2012;119:2609-2615

Study Summary

When treating macular holes, the combination of pars plana vitrectomy and internal limiting membrane peeling has significantly improved anatomical outcomes and best-corrected visual acuity (BCVA). Several agents have been used to make the internal limiting membrane more visible; these include indocyanine green, trypan blue, triamcinolone acetate, and, most recently, brilliant blue G. This study evaluated macular morphology and function after internal limiting membrane peeling for macular holes with either indocyanine green or brilliant blue G.

This study retrospectively reviewed 63 eyes diagnosed with macular holes, of which 35 were treated with brilliant blue G-assisted pars plana vitrectomy plus internal limiting membrane peeling and 28 were treated with indocyanine green-assisted pars plana vitrectomy plus internal limiting membrane peeling. All patients were evaluated preoperatively and then postoperatively at 3 and 6 months. At each visit, spectral-domain optical coherence tomography was used to evaluate the photoreceptor inner segment/outer segment junction, external limiting membrane, and central foveal thickness, and microperimetry was used to assess retinal sensitivity.

This study showed that compared with indocyanine green, brilliant blue G-assisted pars plana vitrectomy plus internal limiting membrane peeling provided statistically significant improved postoperative BCVA and retinal sensitivity, as well as more rapid restoration of the inner segment/outer segment junction. The fact that central foveal thickness was statistically thinner in eyes after indocyanine green is noteworthy. Effectively, brilliant blue G may be a better agent than indocyanine green to make the internal limiting membrane more visible.

Viewpoint

This study holds significance for current clinical practice because it provides evidence that brilliant blue G may be more effective and less toxic than indocyanine green when attempting to make the internal limiting membrane more visible in the closure of macular hole. These results have implications for patient safety and for achieving desired anatomical endpoints. Prospective multicenter studies with patient randomization may shed further light on this finding.

Abstract

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