Indocyanine green
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Central scotoma following drug toxicity: case report A 63-year-old man developed drug toxicity with central scotoma following staining with indocyanine green for internal limiting membrane (ILM) visibility during vitrectomy and fovea-sparing ILM peeling procedure. The man, who was diagnosed with myopic traction maculopathy (MTM) in 2011, was referred to hospital with worsening of bestcorrected visual acuity (BCVA). He underwent lensectomy and pars plana vitrectomy for a nuclear cataract with implantation of an intraocular lens. During the vitrectomy procedure, triamcinolone acetonide was administered for more visibility of posterior vitreous cortex and further ILM forceps and vitreous cutter were used for dissection. Then, 0.125% indocyanine green was injected over the macular area (intraocular route) to stain the ILM, which was immediately washed out. However, indocyanine green staining was repeated three times to make ILM more visible during the ILM removal. Afterwards, ILM was peeled from the macular area excluding the region over foveal area. The residual ILM was about one-disc diameter. One year later, optical CT examinations showed a resolution of the macular retinoschisis associated with MTM along with an intact ellipsoid zone at the fovea. However, oedema in the macular region was noted predominantly in the outer plexiform layer and inner nuclear layer. His BCVA had worsened to 20/200. Goldmann perimetry revealed a central scotoma with associated constriction of the nasal visual field of the right eye. Optical CT angiography showed abnormal blood flow corresponding to the area of the residual ILM suggesting central scotoma following indocyanine green toxicity. The multifocal electroretinograms (mfERGs) were decreased in the central retina of his right eye [outcome not stated]. Mito T, et al. Central scotoma after indocyanine green assisted fovea-sparing internal limiting membrane peeling. American Journal of Ophthalmology Case Reports 20: no pagination, Dec 2020. Available from: URL: http://doi.org/10.1016/j.ajoc.2020.100942 803515756
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Reactions 21 Nov 2020 No. 1831
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