Retinal toxicity of indocyanine green

Purpose: To describe a case of scattered toxicity of indocyanine green on the outer retina and retinal pigment epithelium (RPE) after indocyanine green (ICG) assisted membrane peeling for macular pucker. Methods: A 61-year-old woman was examined by slit-lamp biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT), 1 month and 1 year after ICG assisted membrane peeling for macular pucker. Results: In the absence of significant fundoscopic changes, we have noted on FA and ICGA an occurrence of scattered unusual outer retinal and pigment epithelial changes at the 1- and the 12-month follow-up, probably due to the enhanced phototoxicity associated with the use of ICG at a high concentration (0.5%). Conclusions: Retinal toxicity of ICG in macular surgery depends on many factors. In our patient, the retinal changes seem to have been caused by a combination of all the toxic factors. This is the first reported case describing both the angiographic and OCT patterns of diffuse scattered toxicity of ICG on outer retinal layers and pigment epithelium after ICG assisted membrane peeling for macular pucker.