Inverted Internal Limiting Membrane Flap Technique versus Internal Limiting Membrane Peeling for Vitrectomy in Highly Myopic Eyes with Macular Hole-Induced Retinal Detachment: An Updated Meta-Analysis.

Ling Ling,Man Tian,Tao Sun,Yao Liu,Kaibao Ji,Wentian Zhou,Zhe Hu,Yiqiao Xing,Baixing Zhou,Feifei Gao

doi:10.1155/2020/2374650

Abstract

Background The aim of this meta-analysis was to compare morphological and functional outcomes between vitrectomy with the inverted internal limiting membrane (ILM) flap technique and vitrectomy with internal limiting membrane peeling in highly myopic eyes with macular hole- (MH-) induced retinal detachment (MHRD). Methods The PubMed, Web of Science, Embase, and Cochrane Library databases were comprehensively searched from inception to November 10, 2019, for published studies comparing the two techniques for the treatment of MHRD. The outcomes in the collected articles included the postoperative MH closure rate, retinal reattachment rate, and best-corrected visual acuity (BCVA). Review Manager (version 5.3) was used for analyses. Results In total, seven retrospective studies comparing the inverted ILM flap technique with ILM peeling for the treatment of MHRD were included. The MH closure rate was significantly higher in the inverted ILM flap group than in the ILM peeling group at 6 and 12 months after initial surgery (OR = 15.39; 95% CI: 6.68 to 35.43;P < 0.00001 and OR = 12.58, 95% CI: 3.51 to 45.08; P=0.0001), while the retinal reattachment rate was similar in both groups at 6 months after initial surgery (OR = 2.40; 95% CI: 0.89 to 6.50; P=0.08). Besides, the postoperative BCVA was significantly better in the inverted ILM flap group than in the ILM peeling group at 12 months after initial surgery (MD = −0.35; 95% CI: −0.52 to −0.18; P < 0.0001). Conclusions Thus, the MH closure rate and postoperative BCVA may be better with the inverted ILM flap technique than with ILM peeling for myopic MHRD, while the postoperative retinal reattachment rate appears to be similar with both techniques. Therefore, in the future, vitrectomy with the inverted ILM flap technique should be preferred over standard ILM peeling technique for the treatment of MHRD in highly myopic eyes.

Highlights

Retinal detachment (RD) resulting from the macular hole (MH), known as macular hole- (MH-)induced RD (MHRD), most commonly occurs in eyes with high myopia and results in irreversible visual disorders [1]. e incidence of MHRD accounts for nearly 0.5%–5% of all cases of rhegmatogenous RD worldwide [2]. e potential pathogenesis may be related to tangential macular traction due to the premacular membrane and posterior vitreous cortex complex, inverse traction caused by a posterior staphyloma, or retinal pigment epithelium (RPE) atrophy [3, 4]
Two reviewers (Ling Ling and Kaibao Ji) independently searched the PubMed, Web of Science, Embase, and Cochrane Library databases from inception to November 10, 2019, for all published papers comparing the inverted internal limiting membrane (ILM) flap technique with ILM peeling for MHRD. e search terms were as follows: (((high myopia) odds ratios (OR) highly myopic)) AND (((((retinal perforations OR macular hole OR retinal break OR retinal tear OR retinal hole OR MH)) AND (Retinal detachment OR Retinal Pigment Epithelial Detachment OR RD)) AND) AND (Vitrectomy OR Vitrectomies))
We analyzed seven eligible studies comparing vitrectomy with the inverted ILM flap technique and vitrectomy with ILM peeling for the treatment of MHRD in highly myopic eyes. e pooled results indicated that the MH closure rate and postoperative best-corrected visual acuity (BCVA) were significantly better with the former procedure, the retinal reattachment rate and ellipsoid zone (EZ) were comparable between groups

Summary

Introduction

Retinal detachment (RD) resulting from the macular hole (MH), known as MH-induced RD (MHRD), most commonly occurs in eyes with high myopia and results in irreversible visual disorders [1]. e incidence of MHRD accounts for nearly 0.5%–5% of all cases of rhegmatogenous RD worldwide [2]. e potential pathogenesis may be related to tangential macular traction due to the premacular membrane and posterior vitreous cortex complex, inverse traction caused by a posterior staphyloma, or retinal pigment epithelium (RPE) atrophy [3, 4]. Retinal detachment (RD) resulting from the macular hole (MH), known as MH-induced RD (MHRD), most commonly occurs in eyes with high myopia and results in irreversible visual disorders [1]. With an increase in the incidence of high myopia, the number of cases of MHRD has increased dramatically. ILM peeling for MHRD reportedly achieves a high retinal reattachment rate that ranges from 70% to 100% [10, 11], the MH closure rate is relatively low, ranging from 10% to 70% [12]. Studies have revealed that MH closure after PPV for MHRD in myopic eyes is an important prognostic factor for the recovery of visual acuity [14, 15]

Methods

Results

Conclusion