Low-Concentration Infracyanine Green–Assisted Internal Limiting Membrane Peeling in Idiopathic Macular Pucker 25-Gauge Surgery

Abstract

Purpose To investigate the efficacy of 25-gauge infracyanine green–assisted idiopathic macular pucker surgery and to identify prognostic factors. Methods In this retrospective interventional case series, 83 patients with idiopathic macular pucker who underwent 25-gauge surgery with infracyanine green–assisted internal limiting membrane (ILM) peeling were retrospectively reviewed. Best-corrected visual acuity (BCVA) measurement, complete ophthalmologic evaluation, and optical coherence tomography were performed at baseline and during follow-up. Preoperative and postoperative prognostic factors were correlated with final visual outcomes. Results Mean follow-up was 10.5 months (range 3-44). Best-corrected visual acuity improved from 0.56±0.27 logMAR (±SD) to 0.26 ±0.18 logMAR (p<0.001); central retinal thickness decreased from 441±115 μm to 355±72 μm (p<0.001). Greater postoperative visual gain was correlated with baseline BCVA (r=–0.65, p<0.0001), and BCVA gain after 1 week (r=0.64, p<0.0001) and 1 month (r=0.58, p<0.0001). Final BCVA was influenced by baseline BCVA (r=0.46, p<0.0001), BCVA change after 1 month (r=0.34, p=0.002), and presence of intraretinal fluid (r=0.28, p=0.01). No cases of endophthalmitis, retinal tears, or retinal detachments were reported. Conclusions Low-concentration infracyanine green–assisted ILM peeling during minimally invasive surgery is associated with significant visual acuity improvement. Preoperative BCVA and optical coherence tomography appearance may be helpful in predicting the final visual outcome.