Surgery: Basics of Epiretinal Membrane Peeling with ICG

Dr. Kitchens: One of the most common procedures that we perform is an epiretinal membrane removal. And it’s always one of the most rewarding as well. Anytime I’m operating on a pseudophakic patient, I like to be sure and open the posterior capsule. There’s nothing worse than clearing floaters out from an eye and having the patient develop floaters after you add capsulotomy.

Now I use the ICG primarily to stain the internal limiting membrane and negatively stain the epiretinal membrane. But it can also be used to identify the vitreous. And here I’m using it to identify the vitreous. And it actually assists me in aiding in the elevation of the vitreous, as I take this vitreous up and away, I’m aspirating. And now I’m elevated my posterior hyaloid and I’m performing my peripheral vitreous removal. And this, in essence, gave me that posterior vitreous separation. Very light staining of the ILM and epiretinal membrane. And here you can see the epiretinal membrane with a good pinch and peel comes up nicely in about three or four pieces, really, really well here.

Now, I always like to go back and restain with ICG to make sure that I have the internal limiting membrane up. Having that internal limiting membrane gone reduces the recurrence rate, in my experience, from about 20% down to around 2%. And so I do like to enlarge that ILM peeling. But you can see here that the ILM came up, for the most part, on the back of the epiretinal membrane. So we’ll just enlarge that a little bit. And then once we’re all done, we’ll perform depression to make sure there’s no tears. Thanks so much for watching.