Intravitreal Staining of the Internal Limiting Membrane Using Indocyanine Green in the Treatment of Macular Holes

Surgical management of macular holes consists of pars plana vitrectomy, removal of the posterior hyaloid facia, and peeling of the epiretinal membranes (ERM). Additionally, removal of the internal limiting membrane (ILM) may enable an increase in the anatomic and functional success rates. However, recognition of fine ILM is difficult thus increasing the time that the macula is exposed to intraoperative light. Staining the ILM with indocyanine green (ICG) dye during vitrectomy facilitates recognition of the ILM and assures that all adjacent ERM are removed. Therefore, ICG-assisted ILM peeling has gained worldwide popularity among vitreoretinal surgeons. However, there are some concerns about the intravitreal ICG application. Reports in the literature described a variety of application techniques using different concentrations. The postoperative outcomes were controversial reporting heterogeneous anatomical and functional outcomes after ICG application, as well as descriptions of adverse effects related to the dye. We discuss the indications, techniques, surgical results, and complications after intravitreal ICG injection for the treatment of macular holes.