34.3.3 Toxicity11

To reduce the risk of RPE or retinal damage by the ICG, a number of steps should be taken12:

•Keep the light pipe even further away from the retina than otherwise while the dye is in the eye.

•Make sure the dye is iso-osmolaric.

–Dissolve the 25 mg of ICG powder in 5% glucose, not in its original vehicle.13

•Minimize the time of dye contact with the retina.

•Avoid injecting directly into a macular hole and try to limit the time of dye contact with the RPE.

–Aspirate the dye from the macular hole when you remove the ICG from the vitreous cavity.

–Maximal drying of the surface at the end of F-A-X (see Sect. 50.2.4) is also helpful in preventing the dye from remaining in contact with the RPE.

If the indication for ILM peeling is not a macular hole, the risk of toxicity is dramatically lower.

34.4Newly Formed (PVR) Membranes

Trypan blue is the dye that makes these membranes visible. The dye should be used with an intravitreal air bubble to protect the posterior capsule from being stained. Mixing the dye with 50% dextrose or using it at cold temperature are not good alternatives when large retinal areas need to be stained.

11It is not really an issue in eyes without a macular hole (i.e., no dye access to the subretinal space).

12Having followed what is outlined here, I have not seen a single case of toxicity in several thousands of eyes with ICG staining.

13Water.