Visual Field Defects After Intravitreous Administration of IndocyanineGreen in Macular Hole Surgery

OBJECTIVES: To report the findings on a patient cohort with visual field defects after macular hole surgery with indocyanine green (ICG)-assisted internal limiting membrane peeling and to investigate the correlation between the defects and the use of ICG. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Thirty-nine eyes of 38 patients having the clinical diagnosis of a macular hole who underwent pars plana vitrectomy between January 1, 2001, and December 31, 2002, were enrolled in this study. INTERVENTION: Indocyanine green-assisted internal limiting membrane peeling was performed on a series of 22 eyes: 12 eyes using a 0.5% ICG solution and 3-minute exposure to the retina (group 1), 4 eyes using a 0.5% ICG solution and immediate washout (group 2), and 6 eyes using a 0.25% ICG solution and immediate washout (group 3). The remaining 17 eyes underwent vitrectomy without ICG-assisted internal limiting membrane peeling (group 4). MAIN OUTCOME MEASURES: Visual field, best-corrected visual acuity, and fundus photography were evaluated. RESULTS: Postoperatively, all patients (100%) in group 1 and 1 (25%) of 4 eyes in group 2 had visual field defects. None of the patients in group 3 had a visual field defect. The visual field defects included 10 eyes (84%) with nasal defects, 1 eye (8%) with an inferotemporal defect, and 1 eye (8%) with an extensive visual field defect. Ophthalmoscopy revealed mild to moderate optic disc pallor in 8 (62%) of 13 eyes with postoperative visual field defects. Only 1 patient in group 4 had an inferotemporal defect; none of the other patients in group 4 had visual field defects. There was no statistically significant difference in postoperative visual acuity between patients with and without postoperative visual field defects. CONCLUSIONS: Although this study was limited by the few patients enrolled, our experience indicates that visual field defects, specifically nasal defects, can occur after macular hole surgery with ICG-assisted internal limiting membrane peeling, and that the incidence depends on the concentration of the ICG solution and/or the exposure time to the retina. Further studies are needed to clarify the pathomechanism of visual field defects.