Pleuroperitoneal communication (PPC) affects 1.6-10% of continuous ambulatory peritoneal dialysis patients and often leads to discontinuation of peritoneal dialysis. In PPC, an important aspect is not only the diagnosis but also the detection of the diaphragmatic defect. Traditional methods have often failed to detect small defects, which contributes to the recurrence of PPC. We present three cases of intractable diaphragmatic defects in PPC, successfully localized and treated using indocyanine green (ICG) fluorescence staining of peritoneal dialysate, visualized with an infrared camera. After detecting the defect, surgical repair involved defect plication and the application of talc for pleural adhesion. This approach enabled immediate and successful on-site repair, allowing all patients to resume peritoneal dialysis post-surgery. Even the smallest diaphragmatic defects were accurately identified using ICG fluorescence dye dissolved in peritoneal dialysate. This case series demonstrates that ICG fluorescence staining enhances the diagnosis and treatment of PPC by improving defect localization. Our protocol shows promise in increasing diagnostic accuracy, reducing recurrence rates, and helping patients maintain their preferred dialysis modality.