A Prospective Study Of Surgical Outcomes And Bleb Morphology Using Indocyanine Green As A Surgical Dye In Trabeculectomy With Mitomycin C

1. Dr Kenneth Chan
2. Dr Ghee Soon Ang
3. Dr Wayne Birchall
5. Dr Tracey Wong
5. Dr Graham Reeves
6. Dr Anthony Wells

Eye Department, Wellington Hospital, Wellington, New Zealand

Purpose: To investigate the effect of adding Indocyanine Green (ICG) to Mitomycin C (MMC) in augmented trabeculectomy.

Method: A solution containing 12.5 mg/mL of ICG was added to MMC, resulting in an MMC concentration of 0.2-0.4 mg/mL, which was applied to bare sclera and Tenon's capsule for 3 minutes during trabeculectomy. Intraoperative events, surgical outcomes and complications were noted.

Results: Thirty nine (39) eyes were followed up for twelve months. ICG could be visualised on clinical examination for all eyes on the first postoperative day. Siedel-positive wound leak within the first two weeks of surgery was observed in 4 eyes (10.3%), all of which resolved spontaneously without further complication. Mean intraocular pressure (IOP) decreased from 22.6 mmHg to 12.2 mmHg postoperatively (P < 0.001) at twelve months. Thirty six eyes (92.3%) achieved an IOP of 18 mmHg or less at final visit, with none requiring additional topical intraocular pressure lowering medications. Three eyes (7.7%) developed bleb failure and required glaucoma drainage device implantation at days 75, 110 and 337 respectively. There were no cases of blebitis or late bleb leak. No adverse effects attributable to ICG could be identified postoperatively.

Conclusion: The addition of ICG during trabeculectomy improves the visibility of antimetabolites intraoperatively and allows for the estimation of antimetabolite treatment area intraoperatively and postoperatively. It appears to have no adverse effect on surgical outcomes and complication rates, while improving safety of antimetabolite use.