Comparison of Vitrectomy with Brilliant Blue G or Indocyanine Green on Retinal Microstructure and Function of Eyes with Macular Hole

Purpose To evaluate the microstructure of the inner and outer retina and the visual function after macular hole (MH) surgery using brilliant blue G (BBG) or indocyanine green (ICG) to make the internal limiting membrane (ILM) more visible. Design Comparative, retrospective, interventional case series. Participants Sixty-three eyes of 63 consecutive cases with MH were studied. Thirty-five eyes of 35 cases were treated with BBG between January and August 2011. Twenty-eight eyes of 28 MH cases were treated with ICG from April 2009 through April 2010. Methods Vitrectomy was performed with a 23-gauge system and 0.25 mg/ml BBG or with 0.125% ICG. Main Outcome Measures The best-corrected visual acuity (BCVA) and the microperimetry-determined retinal sensitivity were measured at baseline and at 3 and 6 months after surgery. The length of the defect of the photoreceptor inner segment/outer segment (IS/OS) junction and external limiting membrane (ELM), the central foveal thickness (CFT), and the thickness of the ganglion cell complex (GCC) were measured in the spectral-domain optical coherence tomographic images. Results The average BCVA was significantly better in the BBG group than in the ICG group at 3 months ( P = 0.021) and 6 months ( P = 0.045) after surgery. The mean retinal sensitivity in the BBG group was improved significantly in the central 2° at 3 and 6 months ( P = 0.001 and P = 0.030, respectively), but was not significantly improved in the adjacent 10°. The length of IS/OS junction defect was significantly shorter in the BBG group at 3 months ( P = 0.048), but was not significantly different at 6 months ( P = 0.135). The length of ELM defect and the GCC thickness were not significantly different between the 2 groups at 3 and 6 months. The CFT was significantly thinner in the ICG group than in the BBG group at 3 and 6 months ( P = 0.013 and P = 0.001, respectively). Conclusions The postoperative BCVA and retinal sensitivity in the central 2° were better in eyes after BBG-assisted vitrectomy. The restoration of IS/OS junction was faster in the BBG group, and the CFT was significantly thinner in eyes after ICG. Brilliant blue G may be a better agent than ICG to make the ILM more visible. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.