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

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.