Toxicity profiles of subretinal indocyanine green, Brilliant Blue G, and triamcinolone acetonide: a comparative study
Rasmus Ejstrup1, M la Cour, S Heegaard
1Department of Ophthalmology, Glostrup Hospital, University of Copenhagen, Nordre Ringvej 57, 2600, Glostrup, Denmark. rasmusejstrup@hotmail.com
Background:
This study introduces a novel porcine model to examine the histopathological and electrophysiological consequences of retinotoxicity exerted by dyes commonly used for internal limiting membrane (ILM) staining.
Methods:
Indocyanine green (ICG) 0.5 mg/ml, Brilliant Blue G (BBG) 0.25 mg/ml and triamcinolone acetonide (TA) 13 mg/ml was injected subretinally in 12 vitrectomized pig eyes. At 6 weeks, retinas were examined by multifocal electroretinography (mfERG), ophthalmoscopy, fluorescein angiograpy, histopathology, and apoptosis assay.
Results:
mfERG responses were significantly lower in ICG-injected eyes than in healthy fellow eyes (p = 0.039). The ratio between injected eyes and healthy fellow eyes was lower in the ICG group than in the BBG (p = 0.009) and TA group (p = 0.025). No difference between BBG and TA existed. All retinas were reattached, and fluorescein angiographies showed a window defect corresponding to the injected areas but no blood-retina barrier break-down. Histopathology confirmed damage to the outer retina after ICG, but not after BBG and TA. No apoptosis was found at 6 weeks.
Conclusions:
Subretinal ICG induces histological and functional damage to the retina, suggesting that ICG should be used with caution in macular hole surgery, where subretinal migration can occur. In contrast, BBG and TA appear safe after subretinal injection.
