Objective To observe the characteristics of nearinfrared fundus fluorescence (NIR-FF) after indocyanine green (ICG) assisted internal limiting membrane peeling. Methods Twenty-two eyes of twenty patients (12 eyes with macular hole, 6 eyes with epiretinal membrane, 1 eye with central retinal vein occlusion, 3 eyes with diabetic retinopathy) who underwent pars plana vitrectomy (PPV) with ICGassisted internal limiting membrane peeling were enrolled in this study. ICG solution at a concentration of 0.125 mg/ml was injected. All the patients were examined by fundus photography. Fundus fluorescein angiography (FFA) and ICGA were performed in some patients. Spectralis optical coherence tomography (SD-OCT) were performed to observe retinal microstructural changes. One day, 2 weeks-1 month, 1.5 -2 months, 2.5- 5 months, 6 - 12 months after surgery, the ICG metabolism was observed. Results No ICG staining of the fundus was visible ophthalmoscopically and there was no ICG fluorescence in preoperative NIR-FF of 13 eyes. Every eye had a round reduced fluorescence area in the macula and hyperfluorescence in optic disc, while five eyes were followed for up to 5 months and 1 eye was followed for 1 year after surgery. Within the round reduced fluorescence region, the membrane like structure was observed in 16 eyes during 2 weeks to 5 months after surgery and the other 6 eyes showed ILM deficiency in SD-OCT. One eye demonstrated that resident ICG scattered across the macula once on the first postoperative day, and the optic nerve fiber showed especially intense fluorescence in the area along the vascular arcade from 2 weeks to 1 year after PPV and then disappeared. Otherwise, there was enhanced ICG fluorescence in macular hole, photocoagulation scars, resident proliferative membrane and retinal pigment epithelium detachment (RPED) and drusen area, while hypofluorescence was observed in retinal and choroidal atrophy. Conclusions There are weak fluorescence areas in the macula and choroidal atrophy, while hyperfluorescence in optic disc, macular hole, photocoagulation scars, resident proliferative membrane, RPED and drusen area after ICGassisted vitrectomy. ICG metabolic duration is longer, lasting up to 1 year after surgery.
Objective To observe the choroidal changes of diabetic macular edema (DME) with serous macular detachment (SMD) in non-proliferative diabetic retinopathy (NPDR) patients by optical coherence tomography (OCT).Methods Nine NPDR patients including DME with SMD in one eye (SMD group) and only DME in the other eye (DME group) were enrolled. These 18 eyes were also divided into PRP group (six eyes, received panretinal photocoagulation before) and non-PRP group (12 eyes). Spectral domain EDI (enhance depth imaging) OCT and fundus photograph were performed in all the eyes. The subfoveal choroidal thickness was measured. The choroidal simulation area acquired by horizontal EDI-OCT scan through the center of the fovea was calculated by Image Plus Pro 6.0 software. The difference between DME and SMD group was compared and analyzed with matched t- test; the difference between PRP and non-PRP group was compared and analyzed with F test.Results In SMD group, spindle-like or domelike low signal of detachment areas with intact external limiting membrane were found in the retinal detachment region, and the inner and outer segments (IS/OS) were separated from the retinal pigment epithelium (RPE) Bruch membrane. Both subfoveal choroidal thickness and choroidal simulation area in SMD group were significant greater than those in DME group (t=2.306, 2.306;P＜0.05). Choroidal simulation area in PRP group was larger than that in nonPRP group (F=5.227,P＜0.05). But there was no significant difference of subfoveal choroidal thickness between PRP and non-PRP group (F=3.276,P＞0.05). Conclusion EDI-OCT detects spindlelike or domelike low signal areas in detachment region of SMD with DME in NPDR patients.