Abstract
BackgroundTo evaluate the effects on vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with inverted internal limiting membrane flap technique for macular hole-induced retinal detachment (MHRD).MethodsPubmed, Cochrane Library, and Embase were systematically searched for studies that compared ILM peeling with inverted ILM flap technique for macular hole-induced retinal detachment. The primary outcomes are the rate of retinal reattachment and the rate of macular hole closure 6 months later after initial surgery, the secondary outcome is the postoperative best-corrected visual acuity (BCVA) 6 months later after initial surgery.ResultsFour studies that included 98 eyes were selected. All the included studies were retrospective comparative studies. The preoperative best-corrected visual acuity was equal between ILM peeling and inverted ILM flap technique groups. It was indicated that the rate of retinal reattachment (odds ratio (OR) = 0.14, 95% confidence interval (CI):0.03 to 0.69; P = 0.02) and macular hole closure (OR = 0.06, 95% CI:0.02 to 0.19; P < 0.00001) after initial surgery was higher in the group of vitrectomy with inverted ILM flap technique than that in the group of vitrectomy with ILM peeling. However, there was no statistically significant difference in postoperative best-corrected visual acuity (mean difference (MD) 0.18 logarithm of the minimum angle of resolution; 95% CI −0.06 to 0.43 ; P = 0.14) between the two surgery groups.ConclusionCompared with ILM peeling, vitrectomy with inverted ILM flap technique resulted significantly higher of the rate of retinal reattachment and macular hole closure, but seemed does not improve postoperative best-corrected visual acuity.
Highlights
To evaluate the effects on vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with inverted internal limiting membrane flap technique for macular hole-induced retinal detachment (MHRD)
The onset and progression of MHRD might be related to tangential traction due to the epiretinal membrane and posterior vitreous cortex complex, atrophy of the retinal pigment epithelium, disorder of internal limiting membrane (ILM), and vertical traction by the retina that cannot stretch after staphylomatous elongation of the globe [3,4,5]
Various surgical methods have been attempted to achieve improvement of anatomic and functional for MHRD, including macular buckling, pars plana vitrectomy, vitrectomy with scleral imbrications, vitrectomy with ILM peeling [6,7,8,9], among which vitrectomy with ILM peeling was thought to one of the most effective surgical procedures for MHRD, which achieved in a relatively high initial retinal reattachment rates ranging from 42% to 93%, but a relatively poor initial macular hole closure rates ranging from 10% to 70% [10,11,12,13]
Summary
To evaluate the effects on vitrectomy with internal limiting membrane (ILM) peeling versus vitrectomy with inverted internal limiting membrane flap technique for macular hole-induced retinal detachment (MHRD). Macular hole-induced retinal detachment (MHRD) often cause severe visual impairment, it occurs mainly in older with highly myopic eyes exist posterior staphyloma [1, 2]. We conducted a metaanalysis to compare the effects of vitrectomy with ILM peeling vs vitrectomy with inverted ILM flap technique for MHRD, the rate of retinal reattachment, the rate of macular hole closure 6 months later after initial surgery and the postoperative BCVA 6 months later after initial surgery are used to compare the effects of the two surgery groups
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