To evaluate the anatomical closure rate and visual outcomes in patients undergoing pars plana vitrectomy with internal limiting membrane peeling with either indocyanine green staining and methylcellulose protection of the macular hole (group 1) or brilliant blue staining of the ILM (group 2).


Non-controlled, retrospective case series of 187 eyes which underwent macular hole surgery between March 2007 and October 2009. 167 eyes were available for a follow-up of more than 6 months (average about 2 years in both groups). In group 1 (88 eyes), brilliant blue dye was directly applied to the macula. In group 2 (79 eyes), Indocyanine green was used for staining but only after applying a bubble of methyl cellulose over the fovea to protect the retinal pigment epithelium from direct contact with the dye. In 8 eyes of group 1, ICG had to be applied in addition to the brilliant blue for better visualization during the surgery. Those 8 eyes were moved to group 2 for analysis.


The anatomical closure rate was about 97% in both groups. The mean preoperative decimal VA was 0.18 in group 1 (BB) and 0.21 in group 2 (ICG).  The mean postoperative decimal VA was 0.44 in group 1 and 0.4 in group 2. The differences were not statistically significant.  The mean improvement of visual acuity was -0.39 LogMAR units in group 1 and -0.253 LogMAR units in group 2. Again those differences were not statistically significant.


Both the final visual acuities as well as the visual gains were slightly better in the group treated with brilliant blue alone as compared to the group where ICG was used in conjunction with methylcellulose protection to the macular hole. However, those differences were not statistically significant.