Comparison Of Retinal Microstructure And Function Between Indocyanine Green And Triamcinolone Acetonide-Assisted Internal Limiting Membrane Peeling For Idiopathic Macular Hole

Purpose:To compare the postoperative changes of the best corrected visual acuity(BCVA)and the microstructure of the inner and outer retina in patients with idiopathic macular holes(IMH) undergoing pars plana vitrectomy(PPV) with indocyanine green-(ICG-),or triamcinolone acetonide-(TA-)assisted internal limiting membrane(ILM) peeling.Methods:Retrospective analysis of the medical records of 57 patients(59 eyes) who were diagnosed as idiopathic macular hole in our hospital(the Department of Ophthalmology of the Second Hospital of Jilin University) from September 2013 to January 2015.All the cases underwent pars plana vitrectomy with internal limiting membrane peeling(ILMP).The eyes were divided into 2 groups based on the use of vital dyes during vitreoretinal surgery.The visual acuity examination, intraocular pressure examination, fundus examination and OCT were performed before and after operation.All patients were examined by spectral-domain optical coherence tomography(SD-OCT) to measure the thickness of the ganglion cell complex(GCC) in each section and observe macular hole closure and the integrity of the photoreceptor inner segment/outer segment(IS/OS) junction and external limiting membrane(ELM)in 1 month,3 months,6 months and 12 months after surgery.Surgical results 1 year after surgery, including changes in best corrected visual acuity, macular hole closure and the microstructure of the retina were evaluated.Rusult1.There were no significant differences between the 2 groups in the baseline characteristics, including age,the duration from onset, intraocular pressure,axial length,preoperative best corrected visual acuity,the integrity of the ELM and the IS/OS junction line,MH diameter and the thickness of GCC(P>0.05).2.The improvement in the BCVA from baseline was significant for both groups at1 month,3 months,6 months and 12 months after surgery(P<0.001).The average BCVA was significantly better in the TA group than in the ICG group at 3 months,6months and 12 months after surgery(P<0.05).3.The macular hole was unclosed after surgery in 1 eye in the ICG group.There were no differences between the 2 groups in the rate of anatomical closure(P>0.05).4.(1)No significant differences between the 2 groups in the integrity of the IS/OS junction line at 1 month,3 months,6 months and 12 months after surgery(P>0.05).(2)There were no differences between the 2 groups in the integrity of the ELM at 1 month,3 months,6 months and 12 months after surgery(P>0.05).(3)The mean GCC thickness of each of the 4 sections had significant decrease compared with preoperative in each group at any of the postoperative time points(P<0.05).The GCC thickness were not significantly different between the 2 groups at each time(P>0.05).5.In the ICG group,4 eyes had elevated intraocular pressure.In the TA group,intraocular pressure was elevated in 3 eyes.No significant differences between the 2 groups(P>0.05). Except mildly elevated intraocular pressure,no intraoperative or postoperative complications were observed.Conclusion:1.ICG and TB can make the ILM better visible and enhance closure rates during dye-assisted ILM peeling.2.Compared with ICG-assisted ILM peeling,the postoperative BCVA were better in eyes after TA-assisted vitrectomy.TA may be a better agent than ICG.3.No significant differences between the 2 groups in the retinal microstructure.A possible reason for the decrease in GCC thickness after vitrectomy is the mechanical damage to the retina by ILM peeling.Results:4.The postoperative VA was associated with the restoration of IS/OS and ELM.