Internal limiting membrane peeling versus no peeling during primary vitrectomy for rhegmatogenous retinal detachment: A systematic review and meta-analysis

Matteo Fallico, Andrea Russo, Antonio Longo, Alfredo Pulvirenti, Teresio Avitabile, Vincenza Bonfiglio, Niccolò Castellino, Gilda Cennamo, Michele Reibaldi, Matteo Fallico, Andrea Russo, Antonio Longo, Alfredo Pulvirenti, Teresio Avitabile, Vincenza Bonfiglio, Niccolò Castellino, Gilda Cennamo, Michele Reibaldi

Abstract

Background: Internal limiting membrane (ILM) peeling during primary vitrectomy for rhegmatogenous retinal detachment (RRD) prevents the formation of postoperative macular epiretinal membrane (ERM). However, studies that compared vitrectomy with and without ILM peeling for RRD, have reported controversial outcomes.

Objective: To assess the efficacy of ILM peeling versus non-ILM peeling during vitrectomy for RRD by a systematic review and meta-analysis of published studies.

Methods: PubMed, Medline, Web of Science, Embase databases, and the Cochrane Library were searched up to April 2018 to identify studies that compared primary vitrectomy with and without ILM peeling for RRD with at least six months follow-up. Primary outcomes were the rate of postoperative ERM formation and mean best corrected visual acuity (BCVA) change after vitrectomy. Rate of recurrence of retinal detachment (RD) was assessed as secondary outcome. Risk ratios (RRs) with 95% confidence intervals (CIs) expressed pooled results for rate of ERM formation and rate of RD recurrence in ILM peeling and non-ILM peeling groups. Pooled results for BCVA change in the two groups were expressed as Weighted Mean Difference (WMD) with 95% CIs.

Results: Nine studies, one of which was a randomized controlled trial (RCT), with a total number of 404 eyes in the ILM peeling group and 365 eyes in the non-ILM peeling group, were included. The analysis from pooled data indicated a significant lower rate of postoperative ERM formation in the ILM peeling group compared to the non-ILM peeling group (9 studies, 769 eyes, RR = 0.14; CI: 0.07 to 0.28; P < 0.001). There was no statistical difference in mean BCVA change (9 studies, 769 eyes, WMD = 0.02; CI: -0.11 to 0.16; P = 0.75). Rate of recurrence of RD was lower in the ILM peeling group (6 studies, 603 eyes, RR = 0.32; CI = 0.17 to 0.61; P< 0.001).

Conclusion: ILM peeling during vitrectomy for RRD prevents the formation of macular epiretinal membrane postoperatively and reduces the incidence of RD recurrence, but better visual outcome was not found compared to non-ILM peeling vitrectomy.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of the study…
Fig 1. Flow diagram of the study selection process.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi: 10.1371/journal.pmed1000097For more information, visitwww.prisma-statement.org.
Fig 2. A forest plot showing the…
Fig 2. A forest plot showing the rate of macular epiretinal membrane development following ILM peeling and non-ILM peeling vitrectomy.
Fig 3. A forest plot showing mean…
Fig 3. A forest plot showing mean BCVA change following ILM peeling and non-ILM peeling vitrectomy.
Fig 4. A forest plot showing the…
Fig 4. A forest plot showing the rate of recurrence of retinal detachment following ILM peeling and non-ILM peeling vitrectomy.

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Source: PubMed

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