Indocyanine Green (Intravitreal Chromovitrectomy)

How it works

The dye selectively binds to and stains the internal limiting membrane, improving its visualisation and facilitating safe, complete membrane peeling during vitreoretinal surgery.

Prescribing in practice

• Indocyanine green contains iodide and is contraindicated in patients with iodine hypersensitivity, and retinal toxicity has been reported, so it must be used at the lowest effective concentration with minimal retinal exposure time.
• It must be reconstituted and used strictly according to the product information and only by clinicians trained in intraocular dye-assisted surgery.
• Limit light exposure and irrigation contact time on the retina to reduce the potential for phototoxic or direct retinal injury.

Monitoring

Intraoperative use is monitored by the surgical team with postoperative assessment of visual function and retinal integrity for any signs of toxicity.

Counselling the patient

• Inform the surgical team and patient that a coloured surgical dye is being used to aid membrane visualisation.
• Report any unexpected postoperative visual deterioration promptly for ophthalmic review.

Evidence & guidelines

Concerns about indocyanine green retinal toxicity have driven use of the lowest effective concentration and shortest retinal contact time in vitreoretinal surgical practice.