Conflict/competing interest: None declared.
Prospective study of surgical outcomes and bleb morphology using indocyanine green as a surgical dye in trabeculectomy with mitomycin C
Article first published online: 14 JUN 2012
© 2011 The Authors. Clinical and Experimental Ophthalmology © 2011 Royal Australian and New Zealand College of Ophthalmologists
Clinical & Experimental Ophthalmology
Volume 40, Issue 4, pages e143–e148, May/June 2012
How to Cite
Chan, K. C., Ang, G. S., Birchall, W., Wong, T., Wakely, L., Reeves, G. M., Small, K. M. and Wells, A. P. (2012), Prospective study of surgical outcomes and bleb morphology using indocyanine green as a surgical dye in trabeculectomy with mitomycin C. Clinical & Experimental Ophthalmology, 40: e143–e148. doi: 10.1111/j.1442-9071.2011.02589.x
Funding sources: This work was supported by Capital Vision Research Trust.
- Issue published online: 14 JUN 2012
- Article first published online: 14 JUN 2012
- Accepted manuscript online: 17 MAY 2011 02:10AM EST
- Received 21 November 2010; accepted 26 April 2011.
- case series;
- indocyanine green;
- mitomycin C;
Background: To investigate the effect of adding indocyanine green to mitomycin C in augmented trabeculectomy.
Design: A prospective, non-comparative interventional case series.
Participants: A total of 37 eyes of 37 patients followed up for 1 year.
Methods: A solution containing 12.5 mg/mL of indocyanine green was added to mitomycin C, resulting in an mitomycin C concentration of 0.2–0.4 mg/mL, which was applied to bare sclera and Tenon's capsule for 3 min during trabeculectomy.
Main Outcome Measures: Visual acuity, intraocular pressure, bleb morphology, Moorfields Bleb Grading System scores and complications.
Results: Indocyanine green could be visualized on clinical examination for all eyes on the first postoperative day. Mean intraocular pressure decreased from 22.9 ± 6.2 mmHg to 12.1 ± 4.4 mmHg postoperatively (P < 0.001) at 1 year. Thirty-four eyes (91.9%) achieved an intraocular pressure of less than 21 mmHg at final visit without additional topical intraocular pressure-lowering medications. Three eyes (8.1%) developed bleb failure andrequired Baerveldt device implantation. There were no cases of blebitis or late bleb leak. No adverse effects attributable to indocyanine green could be identified postoperatively.
Conclusion: The addition of indocyanine green during trabeculectomy improves the visibility of antimetabolites intraoperatively and allows for the estimation of antimetabolite treatment area intraoperatively and postoperatively. It appears to have no adverse effect on surgical outcomes and complication rates, while improving safety of antimetabolite use.