Functional and anatomic results of macular hole surgery complicated by massive indocyanine green subretinal migration

PURPOSE: To report the functional and anatomic results of macular hole (MH) surgery complicated by massive subretinal migration of indocyanine green (ICG) dye. DESIGN: Interventional case report. METHODS: We performed standard pars plana vitrectomy surgery for a stage 3, senile idiopathic MH. After posterior vitreous detachment and vitreous removal, we instilled 2 ml of ICG (0.5%, 270 mOsm); the surgery was complicated by diffuse subretinal migration of the ICG dye but peeling of the internal limiting membrane (ILM) was performed (despite the obvious difficulties from the low contrast between the green-stained ILM overlying a green-stained subretinal space) and the rest of the procedure was completed with a final injection of 16% C3F8. RESULTS: Post-surgical optical coherence tomography confirmed the anatomic closure of the MH. Digital photography with the excitation and barrier filters for ICG showed a striking autofluorescence along the inferior vascular arcade, which remained intense 7 months after surgery. Despite the massive subretinal migration of ICG, visual acuity (VA) improved to 20/30. CONCLUSIONS: This is the first report of VA recovery despite massive subretinal migration of ICG dye during MH surgery. Subretinal migration of ICG dye may be a potential complication during MH surgery; this should alert the surgeon to limit its use, despite the possible absence of clinically apparent toxic effects.