A recent publication found in Frontiers in Medicine highlights the ability of digital visualization systems, specifically, the NGENUITY®3D Visualization System, to utilize customized settings, enabling surgeons to use a 3-fold lower indocyanine-green (ICG) concentration for internal limiting membrane (ILM) peeling surgery.
In this prospective comparative observational study, consecutive patients undergoing combined phacoemulsification with 25G vitrectomy and ICG-enhanced ILM peeling using a standard operating microscope (SOM) (25 eyes), NGENUITY V 1.1 (12 eyes), or NGENUITY V 1.3 (13 eyes) were enrolled. Patients with a spherical equivalent ≥6.0 diopters or axial length ≥26mm, history of previous ocular surgery, ocular trauma, and corneal diseases, including corneal opacity or corneal dystrophy were excluded. The color contrast ratio (CCR) of the ICG-enhanced ILM between visualization modalities was evaluated in this study. †
After the removal of the ERM, 0.05mL of diluted ICG was injected only once into the vitreous cavity for 30 seconds to stain the ILM, and then quickly washed out. An ICG dye concentration 0.075% was sufficient for ILM visualization under the SOM, while 0.025% ICG (used for NGENUITY V 1.3) was not sufficient, thus all patients in the SOM group received a 0.075% ICG solution, as did those in the NGENUITY V 1.1. Different color channel settings for each digital visualization method were evaluated. †
Findings included the following: †
- The groups did not differ in baseline demographic characteristics
- All macular hole cases from all groups showed closure at 12 months without secondary surgery
- No intraoperative iatrogenic retinal tears or retinal detachments occurred in any group
- In all groups, BCVA at 12 months significantly improved from baseline but there was no significant difference in BCVA between groups at 12 months
- The CCR of the optimal setting for NGENUITY V 1.3 with 0.025% ICG did not differ from that of the optimal customized setting for NGENUITY V 1.1 with 0.075% ICG
In summary, customized color setting in the NGENUITY V 1.3 group, compared to the NGENUITY V 1.1 or the SOM groups, allowed optimal visualization of ICG - assisted ILM peeling where the ICG concentration was reduced 3-fold from 0.075% down to 0.025%. This would be advantageous for macular surgery. †
† Park SJ, Do JR, Shin JP and Park DH. Customized Color Settings of Digitally Assisted Vitreoretinal Surgery to Enable Use of Lower Dye Concentrations During Macular Surgery. Front. Med. 2022.8:810070.
Link to article in Frontiers in Medicine:
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