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

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.

Conflict of interest statement

The authors have no financial conflicts of interest.

Copyright © 2020 Ling Ling et al.

Figures

Figure 1
Figure 1
Flow diagram of the article selection process for meta-analysis.
Figure 2
Figure 2
Forest plot comparing macular hole closure rate between inverted ILM flap and ILM peeling groups at 6 months after surgery. ILM = internal limiting membrane.
Figure 3
Figure 3
Forest plot comparing macular hole closure rate between inverted ILM flap and ILM peeling groups at 12 months after surgery. ILM = internal limiting membrane.
Figure 4
Figure 4
Forest plot comparing retinal reattachment rate between inverted ILM flap and ILM peeling groups at 6 months after surgery. ILM = internal limiting membrane.
Figure 5
Figure 5
Forest plot comparing preoperative BCVA between inverted ILM flap and ILM peeling groups. BCVA = best-corrected visual acuity, ILM = internal limiting membrane.
Figure 6
Figure 6
Forest plot comparing postoperative BCVA between inverted ILM flap and ILM peeling groups at 6 months after surgery. BCVA = best-corrected visual acuity, ILM = internal limiting membrane.
Figure 7
Figure 7
Forest plot comparing postoperative BCVA between inverted ILM flap and ILM peeling groups at 12 months after surgery. BCVA = best-corrected visual acuity, ILM = internal limiting membrane.
Figure 8
Figure 8
A funnel plot of MH closure rate at 6 months after surgery showing no significant publication bias. MH = macular hole, SE = standard error, OR = odds ratio.
Figure 9
Figure 9
A funnel plot of MH closure rate at 12 months after surgery showing no significant publication bias. MH = macular hole, SE = standard error, OR = odds ratio.
Figure 10
Figure 10
A funnel plot of retinal reattachment rate showing no significant publication bias. SE = standard error, OR = odds ratio.
Figure 11
Figure 11
A funnel plot of preoperative BCVA showing no significant publication bias. BCVA = best-corrected visual acuity, SE = standard error, MD = mean difference.
Figure 12
Figure 12
A funnel plot of postoperative BCVA at 12 months after surgery showing no significant publication bias. BCVA = best-corrected visual acuity, SE = standard error, MD = mean difference.

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