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Retinal nerve fibre layer damage after indocyanine green assisted vitrectomy

Recently, indocyanine green (ICG) has been used to stain and visualise the internal limiting membrane (ILM) during vitrectomy.1 Some case series showed that visual field defects on the nasal side can occur after the surgery through unknown cause.2,3 Here, we report a case in which nasal visual field defects occurred after ICG assisted ILM peeling for epiretinal membrane (ERM). Detailed examination revealed that the superior and inferior retinal nerve fibre is severely damaged in this case.

A 60 year old woman who received ICG assisted ILM peeling for ERM in her right eye was referred to our hospital. The preoperative best corrected visual acuity (BCVA) was 20/60 in the right eye. According to the referring ophthalmologist, 25 mg of ICG (Diagnogreen; Daiichi Pharmaceuticals) was dissolved in 10 ml of distilled water, which was further diluted by a viscoelastic material (Healon; Pharmacia) to give 0.16% ICG solution. To stain ILM, ICG was injected into an air filled eye and the dye …