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Color enhancement and achromatization to increase the visibility of indocyanine green-stained internal limiting membrane during digitally assisted vitreoretinal surgery

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the impact of using digital assisted vitrectomy (DAV) for color enhancement in color channel and achromatization in color profile on the visibility of indocyanine green (ICG)-stained internal limiting membrane (ILM).

Study design

Retrospective observational study.

Methods

Twenty eyes from 20 patients (7 men, 13 women) who underwent 27-gauge pars plana vitrectomy for epiretinal membrane removal were included. The presettings of five different imaging modes of the NGENUITY® 3D visualization system (Alcon laboratories, Inc.), were adjusted, and intraoperative images of ILM removal were captured under each presetting. The color contrast ratios (CCR) between the ICG-stained ILM area and peeled ILM area were compared across presettings objectively. Subjective visibility of ILM in each patient for different presettings was ranked using a Likert scale and evaluated by five examiners. Data on sex, age, preoperative and postoperative best-corrected visual acuity (BCVA), preoperative and postoperative intraocular pressure (IOP), and postoperative complications were analyzed.

Results

Compared to other presettings the best CCR was achieved by adjusting the color channel to enhance red and by modifying the color profile to create a monochrome image (P<0.01). The same presetting resulted in a highest subjective visibility (P<0.01). Mean preoperative BCVA and 6-month postoperative BCVA (logMAR) were 0.11±0.18 and 0.05±0.19, respectively (p=0.24). Mean preoperative IOP and 6-month postoperative IOP were 13.8±2.8 mmHg and 13.3±3.4 mmHg, respectively (p=0.51). No apparent intra- and post-operative complications were observed.

Conclusion

Color enhancement and achromatization using DAV may offer potential advantages to enhance the visibility of ICG-stained ILM.

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References

  1. Eckardt C, Eckardt U, Groos S, Luciano L, Reale E. Entfernung der Membrana limitans interna bei Makulalöchern. Klinische und morphologische Befunde [Removal of the internal limiting membrane in macular holes. Clinical and morphological findings]. Ophthalmologe. 1997;94:545–51 (in German)

  2. de Bustros S, Thompson JT, Michels RG, Rice TA, Glaser BM. Vitrectomy for idiopathic epiretinal membranes causing macular pucker. Br J Ophthalmol. 1988;72:692–5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Park DW, Dugel PU, Garda J, Sipperley JO, Thach A, Sneed SR, et al. Macular pucker removal with and without internal limiting membrane peeling: pilot study. Ophthalmology. 2003;110:62–4.

    Article  PubMed  Google Scholar 

  4. Bovey EH, Uffer S, Achache F. Surgery for epimacular membrane: impact of retinal internal limiting membrane removal on functional outcome. Retina. 2004;24:728–35.

    Article  PubMed  Google Scholar 

  5. Sandali O, El Sanharawi M, Basli E, Bonnel S, Lecuen N, Barale P-O, et al. Epiretinal membrane recurrence: incidence, characteristics, evolution, and preventive and risk factors. Retina. 2013;33:2032–8.

    Article  PubMed  Google Scholar 

  6. Schechet SA, DeVience E, Thompson JT. The effect of internal limiting membrane peeling on idiopathic epiretinal membrane surgery, with a review of the literature. Retina. 2017;37:873–80.

    Article  PubMed  Google Scholar 

  7. Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010;117:2018–25.

    Article  PubMed  Google Scholar 

  8. Morizane Y, Shiraga F, Kimura S, Hosokawa M, Shiode Y, Kawata T, et al. Autologous transplantation of the internal limiting membrane for refractory macular holes. Am J Ophthalmol. 2014;157:861-9.e1.

    Article  PubMed  Google Scholar 

  9. Shimada N, Sugamoto Y, Ogawa M, Takase H, Ohno-Matsui K. Fovea-sparing internal limiting membrane peeling for myopic traction maculopathy. Am J Ophthalmol. 2012;154:693–701.

    Article  PubMed  Google Scholar 

  10. Moroi SE, Gottfredsdottir MS, Van Heck T, Musch DC, Johnson MW. Visual field results after vitreous surgery in a case series of patients with open-angle glaucoma. Ophthalm Surg Lasers. 2000;31:380–6.

    Article  CAS  Google Scholar 

  11. Tsuchiya S, Higashide T, Sugiyama K. Visual field changes after vitrectomy with internal limiting membrane peeling for epiretinal membrane or macular hole in glaucomatous eyes. PLoS ONE. 2017;12: e0177526.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kadonosono K, Itoh N, Uchio E, Nakamura S, Ohno S. Staining of internal limiting membrane in macular hole surgery. Arch Ophthalmol. 2000;118:1116–8.

    Article  CAS  PubMed  Google Scholar 

  13. Enaida H, Hisatomi T, Hata Y, Ueno A, Goto Y, Yamada T, et al. Brilliant blue G selectively stains the internal limiting membrane/brilliant blue G-assisted membrane peeling. Retina. 2006;26:631–6.

    PubMed  Google Scholar 

  14. Perrier M, Sébag M. Trypan blue-assisted peeling of the internal limiting membrane during macular hole surgery. Am J Ophthalmol. 2003;135:903–5.

    Article  PubMed  Google Scholar 

  15. Farah ME, Maia M, Penha FM, Rodrigues EB. The use of vital dyes during vitreoretinal surgery—chromovitrectomy. Dev Ophthalmol. 2016;55:365–75.

    Article  PubMed  Google Scholar 

  16. Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: an experimental and clinical study. Retina. 2016;36:137–47.

    Article  PubMed  Google Scholar 

  17. Park SJ, Do JR, Shin JP, Park DH. Customized color settings of digitally assisted vitreoretinal surgery to enable use of lower dye concentrations during macular surgery. Front Med (Lausanne). 2022;8: 810070.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Imai H, Tetsumoto A, Inoue S, Takano F, Yamada H, Hayashida M, et al. Intraoperative three-dimensional fluorescein angiography-guided pars plana vitrectomy for the treatment of proliferative diabetic retinopathy: the maximized utility of the digital assisted vitrectomy. Retina. 2023;43:359–62.

    Article  PubMed  Google Scholar 

  19. Imai H, Tetsumoto A, Yamada H, Hayashida M, Otsuka K, Miki A, et al. Intraoperative three-dimensional fluorescein angiography-guided pars plana vitrectomy for branch retinal vein occlusion. Retin Cases Brief Rep. 2022;16:802–5.

    Article  PubMed  Google Scholar 

  20. Kadonosono K, Arakawa A, Inoue M, Yamane S, Uchio E, Yamakawa T, et al. Internal limiting membrane contrast after staining with indocyanine green and brilliant blue G during macular surgery. Retina. 2013;33:812–7.

    Article  PubMed  Google Scholar 

  21. Bin Helayel H, Al-Mazidi S, AlAkeely A. Can the three-dimensional heads-up display improve ergonomics, surgical performance, and ophthalmology training compared to conventional microscopy? Clin Ophthalmol. 2021;15:679–86.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Weinstock RJ, Ainslie-Garcia MH, Ferko NC, Qadeer RA, Morris LP, Cheng H, et al. Comparative assessment of ergonomic experience with heads-up display and conventional surgical microscope in the operating room. Clin Ophthalmol. 2021;15:347–56.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This work supported by a grant from Alcon, Japan.

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Hisanori Imai, Yukako Iwane, Maya Kishi, Yasuyuki Sotani, Hiroko Yamada, Wataru Matsumiya, Akiko Miki, Sentaro Kusuhara & Makoto Nakamura

Authors
  1. Hisanori Imai
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  2. Yukako Iwane
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  3. Maya Kishi
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  4. Yasuyuki Sotani
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  5. Hiroko Yamada
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  6. Wataru Matsumiya
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  7. Akiko Miki
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  8. Sentaro Kusuhara
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  9. Makoto Nakamura
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Corresponding author

Correspondence to Hisanori Imai.

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Conflicts of interest

H. Imai, None; Y. Iwane, None; M. Kishi, None; Y. Sotani, None; H. Yamada, None; W. Matsumiya, None; A. Miki, None; S. Kusuhara, None; M. Nakamura, None.

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Corresponding Author: Hisanori Imai

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Imai, H., Iwane, Y., Kishi, M. et al. Color enhancement and achromatization to increase the visibility of indocyanine green-stained internal limiting membrane during digitally assisted vitreoretinal surgery. Jpn J Ophthalmol 68, 105–111 (2024). https://doi.org/10.1007/s10384-023-01042-2

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  • DOI: https://doi.org/10.1007/s10384-023-01042-2

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