Progressive indocyanine green toxicity

To report a case of progressive indocyanine green (ICG) toxicity that occurred after pars plana vitrectomy for an epiretinal membrane.

The patient underwent pars plana vitrectomy for an epiretinal membrane. After fluid--air exchange, ICG was spread only on the macular area, and air-fluid exchange was performed immediately. The epiretinal membrane was removed with serrated forceps.

Although the preoperative visual acuity was 0.6, it was 0.2 in the first postoperative month, and fundus fluorescein angiography revealed retinal pigment epithelium atrophy in the macula that matched the area of ICG application. Visual acuity in the fourth postoperative month was 0.1, and there was optic atrophy. During the sixth postoperative month, visual acuity was hand movements, and there were multiple retinal holes in the macula and sclerosis of the arteries.

This study demonstrates that intravitreal use of ICG might have toxic effects on the retina. Unnecessary use of ICG should be avoided, and care must be taken when using intravitreal ICG.