Biomechanical changes of the internal limiting membrane after indocyanine green staining

Selective indocyanine green (ICG) staining of the macula has recently become popular in internal limiting membrane (ILM) peeling allowing a better distinction of the ILM from the underlying retina. Clinically, the ILM seems to become stiffer after ICG staining facilitating ILM peeling for the retinal surgeon. In the present study, we tried to verify the cause of this biomechanical effect. Retinal samples of postmortem porcine eyes were treated with ICG and light and compared to samples treated in darkness using biomechanical force and elongation measurements. After ICG staining of the retina combined with a 3-min illumination, a significant increase in ultimate force by 45% and a decrease in ultimate elongation by 24% were found indicating greater stiffness of the ICG-stained ILM. Without light exposure there was no such effect suggesting a light-dependent process. The stiffening effect of ICG and light is due to a photosensitizing effect of ICG leading to collagen cross-linking of the ILM.