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Noninfectious Endophthalmitis Following Intraoperative Indocyanine Green
Insights
A batch of indocyanine green (ICG) dye caused severe eye inflammation in four patients after surgery. Prompt treatment with steroids and antibiotics led to inflammation resolution within two weeks.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Patient Safety
Background:
- Intraoperative indocyanine green (ICG) is used as a surgical dye.
- Severe postoperative inflammation is a rare complication.
Purpose of the Study:
- To describe a cluster of four severe postoperative inflammation cases.
- To identify the potential cause of inflammation linked to a specific ICG lot.
Main Methods:
- Retrospective chart review of four patients.
- Analysis of the implicated indocyanine green lot using HPLC-UV spectroscopy.
Main Results:
- All four patients developed severe inflammation on postoperative day 1.
- Inflammation resolved in all patients by postoperative day 14 with treatment.
- No contaminants were identified in the ICG lot via HPLC-UV.
Conclusions:
- Intravitreal indocyanine green (ICG) dye can be associated with severe postoperative inflammation.
- Topical corticosteroid and antibiotic treatment can effectively manage this inflammation.
- Further investigation into ICG dye safety is warranted.
Background And Objective:
The purpose of this article is to describe a cluster of four cases of severe postoperative inflammation in eyes that received intraoperative indocyanine green (ICG) from the same lot.
Patients And Methods:
This was a retrospective chart review of patients from a single-center, retina-only group practice. The ICG lot associated with the inflammatory events was identified and analyzed with high-performance liquid chromatography with UV spectroscopy.
Results:
Four patients presented on postoperative day 1 with severe inflammation. The first patient was treated with aqueous biopsy and injection of intravitreal antibiotics, followed by topical steroid and antibiotic drops. The subsequent three patients were treated with topical steroid and antibiotic drops. All patients had resolution of inflammation by postoperative day 14 (range 10 to 14 days). High-performance liquid chromatography with UV spectroscopy failed to identify a contaminant.
Conclusions:
The use of intravitreal ICG dye as a surgical adjuvant may uncommonly be associated with severe postoperative inflammation. This inflammation may resolve within weeks after topical corticosteroid and antibiotic treatment. [.
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