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Diagnostic Dye — Vitreoretinal Surgery / ICG Angiography Pregnancy: Use with caution — iodine component; limited data; avoid unless clearly necessary

Indocyanine Green (Intravitreal Chromovitrectomy)

Brand names: IC-Green

Adult dose

Dose: ICG angiography: 25 mg IV bolus; Chromovitrectomy: 0.5–1 mg/mL diluted solution applied to internal limiting membrane (ILM) intraoperatively
Route: Intravenous (angiography) or Intravitreal/retinal surface (vitreoretinal surgery)
Frequency: Single use (angiography); single intraoperative application (surgery)
Max: 25 mg IV (angiography); lowest effective concentration for ILM staining
ICG angiography: IV injection, imaging within 1–3 minutes (peak choroidal fluorescence). Chromovitrectomy: diluted ICG applied to retinal surface to stain the ILM for macular hole surgery — MUST use preservative-free, low-concentration preparation to avoid retinal toxicity.

Paediatric dose

Dose: 0.1–0.3 mg/kg
Route: IV (angiography)
Frequency: Single injection
Max: 25 mg total
Paediatric indications — under specialist guidance; angiography for suspected choroidal neovascularisation

Dose adjustments

Renal

Use with caution — ICG is entirely hepatically eliminated; renal impairment is less relevant. However, ICG angiography contrast may cause allergic reactions

Hepatic

Use with caution in hepatic impairment — ICG is exclusively liver-extracted; delayed clearance; diagnostic accuracy of liver function test (ICG clearance test) is altered

Paediatric weight-based calculator

Paediatric indications — under specialist guidance; angiography for suspected choroidal neovascularisation

Clinical pearls

  • ICG angiography vs fluorescein angiography: fluorescein angiography visualises retinal vasculature; ICG angiography visualises CHOROIDAL vasculature (ICG is protein-bound and does not leak from fenestrated choriocapillaris as readily as fluorescein) — used for PCV, central serous chorioretinopathy, and occult CNV diagnosis
  • Retinal toxicity in vitreoretinal surgery: when ICG is used to stain the ILM during macular hole surgery — high concentrations cause direct retinal ganglion cell toxicity and visual field defects; strict concentration control (<0.5 mg/mL) and short exposure time are mandatory
  • Shelf life after reconstitution: reconstituted ICG degrades rapidly — use within 10 hours; check for precipitation before use
  • Iodine allergy screening MANDATORY before IV angiography — anaphylaxis, although rare, can be fatal; resuscitation equipment must be immediately available
  • ICG liver function test: ICG clearance is used as a sensitive measure of hepatic reserve (in liver surgery planning); this is distinct from its ophthalmic use but illustrates the drug's unique hepatic elimination

Contraindications

  • Iodine allergy — ICG contains sodium iodide
  • Shellfish allergy (cross-reactivity with iodine compounds)
  • High-concentration intravitreal use — retinal toxicity

Side effects

  • Allergic reactions — mild (nausea) to anaphylaxis (rare, ~1:40,000 IV); higher risk in iodine/shellfish allergy
  • Retinal toxicity with high-concentration intravitreal use — ILM damage, visual field defects reported with concentrations >0.5 mg/mL
  • Green discolouration of stool and urine for 24 hours (normal)
  • Transient nausea (IV angiography)

Interactions

  • Iodine-containing contrast agents — additive iodine load; screen for allergy
  • Heparin — may affect ICG binding

Monitoring

  • Allergy history before IV use
  • Vital signs during IV angiography
  • Postoperative visual field assessment after ILM peeling with ICG

Reference: BNFc; BNF 90; RCOphth ICG Angiography Guidelines; Haritoglou et al. Retina Review (ICG Toxicity); SPC IC-Green. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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