Complete ILM Peeling Versus Inverted Flap Technique for Macular Hole Surgery: A Meta-Analysis
Abstract
BACKGROUND AND OBJECTIVE:
To compare complete internal limiting membrane (ILM) peeling with the inverted flap technique for macular hole (MH) surgery.
PATIENTS AND METHODS:
An electronic database search on PubMed, CENTRAL, and ClinicalTrials.gov was performed. Inclusion criteria were comparative prospective/retrospective studies including patients with MH of any size with at least 6 months of follow-up. The primary outcome was MH closure rate. Secondary outcomes were best-corrected visual acuity improvement and surgery-related adverse events.
RESULTS:
Sixteen papers enrolling 1,403 eyes were included (733 ILM peeling, 670 inverted flap). MH mean minimum diameter and time of symptomatic evolution were higher in the inverted flap group (531.1 μm ± 188.8 μm vs. 602.8 μm ± 223.8 μm; 10.4 ± 20.2 months vs. 12.0 ± 18.4 months; P < .01). Overall, MH closure rate was superior with the inverted flap technique (risk-ratio [RR]: 1.25; 95% confidence interval [CI], 1.14–1.38; P < .0001), as well as in all subgroups: idiopathic large MH (n = 362; RR: 1.12; 95% CI, 1.05–1.20; P < .001), myopic MH without retinal detachment (n = 133; RR: 1.35; 95% CI, 1.14–1.59; P < .001), and MH retinal detachment (n = 198; RR: 1.89; 95% CI, 1.31–2.73; P < .001).
CONCLUSION:
This meta-analysis suggests the inverted flap technique is more effective in achieving MH closure.
[Ophthalmic Surg Lasers Imaging Retina. 2020;51:187–195.]
- 1.McCannel CA, Ensminger JL, Diehl NN, Hodge DN. Population-based incidence of macular holes. Ophthalmology. 2009; 116(7):1366–1369.
10.1016/j.ophtha.2009.01.052 PMID:19576500 > Crossref MedlineGoogle Scholar - 2.Lois N, Burr J, Norrie J, Full-thickness Macular Hole and Internal Limiting Membrane Peeling Study (FILMS) Group. Internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole: a pragmatic randomized controlled trial. Invest Ophthalmol Vis Sci. 2011; 52(3):1586–1592.
10.1167/iovs.10-6287 PMID:21051731 > Crossref MedlineGoogle Scholar - 3.Morescalchi F, Costagliola C, Gambicorti E, Duse S, Romano MR, Semeraro F. Controversies over the role of internal limiting membrane peeling during vitrectomy in macular hole surgery. Surv Ophthalmol. 2017; 62(1):58–69.
10.1016/j.survophthal.2016.07.003 PMID:27491476 > Crossref MedlineGoogle Scholar - 4.Michalewska Z, Michalewski J, Adelman RA, Nawrocki J. Inverted internal limiting membrane flap technique for large macular holes. Ophthalmology. 2010; 117(10):2018–2025.
10.1016/j.ophtha.2010.02.011 PMID:20541263 > Crossref MedlineGoogle Scholar - 5.Baba R, Wakabayashi Y, Umazume K, Efficacy of the Inverted Internal Limiting Membrane Flap Technique With Vitrectomy for Retinal Detachment Associated With Myopic Macular Holes. Retina. 2017; 37(3):466–471.
10.1097/IAE.0000000000001211 PMID:28225722 > Crossref MedlineGoogle Scholar - 6.Bové Álvarez M, Sabaté S, Gómez-Resa M, García-Arumí J. Anatomical And Visual Outcomes Of Inverted Internal Limiting Membrane Flap Technique Versus Internal Limiting Membrane Peeling In Myopic Macular Hole Without Retinal Detachment: A Preliminary Retrospective Study. Retina. 2020; 40(2):233–240.
10.1097/IAE.0000000000002368 PMID:31972792 > Crossref MedlineGoogle Scholar - 7.Moher D, Liberati A, Tetzlaff J, Altman DGPRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097.
10.1371/journal.pmed.1000097 PMID:19621072 > Crossref MedlineGoogle Scholar - 8.Stroup DF, Berlin JA, Morton SC, Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000; 283(15):2008–2012.
10.1001/jama.283.15.2008 PMID:10789670 > Crossref MedlineGoogle Scholar - 9.Wells GA, Shea B, O'Connell D, The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Ottawa Hospital Research Institute website. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Published 2013. > Google Scholar
- 10. , eds. Cochrane Handbook for Systematic Reviews of Interventions. 2nd Edition. Chichester, UK: John Wiley & Sons; 2019. > CrossrefGoogle Scholar
- 11.Ioannidis JPA, Patsopoulos NA, Evangelou E. Heterogeneity in meta-analyses of genome-wide association investigations. PLoS One. 2007; 2(9):e841.
10.1371/journal.pone.0000841 PMID:17786212 > Crossref MedlineGoogle Scholar - 12.Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005; 5(1):13.
10.1186/1471-2288-5-13 PMID:15840177 > Crossref MedlineGoogle Scholar - 13.Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014. > Google Scholar
- 14.Stata Statistical Software [Computer program]. Version 15. College Station, TX: StataCorp LLC, 2017. > Google Scholar
- 15.Sasaki H, Shiono A, Kogo J, Inverted internal limiting membrane flap technique as a useful procedure for macular hole-associated retinal detachment in highly myopic eyes. Eye (Lond). 2017; 31(4):545–550.
10.1038/eye.2016.263 PMID:27911448 > Crossref MedlineGoogle Scholar - 16.Chen SN, Yang CM. Inverted internal limiting membrane insertion for macular hole-associated retinal detachment in high myopia. Am J Ophthalmol. 2016; 166:211.
10.1016/j.ajo.2016.03.053 PMID:27156648 > Crossref MedlineGoogle Scholar - 17.Hu XT, Pan QT, Zheng JW, Zhang ZD. Foveal microstructure and visual outcomes of myopic macular hole surgery with or without the inverted internal limiting membrane flap technique. Br J Ophthalmol. 2019; 103(10):1495–1502.
10.1136/bjophthalmol-2018-313311 PMID:30470714 > Crossref MedlineGoogle Scholar - 18.Iwasaki M, Kinoshita T, Miyamoto H, Imaizumi H. Influence Of Inverted Internal Limiting Membrane Flap Technique On The Outer Retinal Layer Structures After A Large Macular Hole Surgery. Retina. 2019; 39(8):1470–1477.
10.1097/IAE.0000000000002209 PMID:29863535 > Crossref MedlineGoogle Scholar - 19.Lee JJ, Lee IH, Park KH, Vascular displacement in idiopathic macular hole after single-layered inverted internal limiting membrane flap surgery. Korean J Ophthalmol. 2017; 31(4):336–342.
10.3341/kjo.2016.0114 PMID:28682018 > Crossref MedlineGoogle Scholar - 20.Matsumura T, Takamura Y, Tomomatsu T, Comparison of the inverted internal limiting membrane flap technique and the internal limiting membrane peeling for macular hole with retinal detachment. PLoS One. 2016; 11(10):e0165068.
10.1371/journal.pone.0165068 PMID:27764184 > Crossref MedlineGoogle Scholar - 21.Mete M, Alfano A, Guerriero M, Inverted internal limiting membrane flap technique versus complete internal limiting membrane removal in myopic macular hole surgery: a comparative study. Retina. 2017; 37(10):1923–1930.
10.1097/IAE.0000000000001446 PMID:28067723 > Crossref MedlineGoogle Scholar - 22.Narayanan R, Singh SR, Taylor S, Surgical Outcomes After Inverted Internal Limiting Membrane Flap Versus Conventional Peeling For Very Large Macular Holes. Retina. 2019; 39(8):1465–1469.
10.1097/IAE.0000000000002186 PMID:29689027 > Crossref MedlineGoogle Scholar - 23.Ota H, Kunikata H, Aizawa N, Nakazawa T. Surgical results of internal limiting membrane flap inversion and internal limiting membrane peeling for macular hole. PLoS One. 2018; 13(9):e0203789.
10.1371/journal.pone.0203789 PMID:30212576 > Crossref MedlineGoogle Scholar - 24.Rizzo S, Tartaro R, Barca F, Caporossi T, Bacherini D, Giansanti F. Internal limiting membrane peeling versus inverted flap technique for treatment of full-thickness macular holes: a comparative study in a large series of patients. Retina. 2018; 38(S1)(suppl 1):S73–S78.
10.1097/IAE.0000000000001985 PMID:29232338 > Crossref MedlineGoogle Scholar - 25.Takahashi H, Inoue M, Koto T, Itoh Y, Hirota K, Hirakata A. Inverted internal limiting membrane flap technique for treatment of macular hole retinal detachment in highly myopic eyes. Retina. 2018; 38(12):2317–2326. PMID:
29065014 > Crossref MedlineGoogle Scholar - 26.Wu TT, Kung YH, Chang CY, Chang SP. Surgical outcomes in eyes with extremely high myopia for macular hole without retinal detachment. Retina. 2018; 38(10):2051–2055.
10.1097/IAE.0000000000001806 PMID:28796147 > Crossref MedlineGoogle Scholar - 27.Yamashita T, Sakamoto T, Terasaki H, Writing Committee of Japan-Clinical Retina Research Team (J-CREST). Best surgical technique and outcomes for large macular holes: retrospective multicentre study in Japan. Acta Ophthalmol. 2018; 96(8):e904–e910.
10.1111/aos.13795 PMID:29671948 > Crossref MedlineGoogle Scholar - 28.Wakabayashi T, Ikuno Y, Shiraki N, Matsumura N, Sakaguchi H, Nishida K. Inverted internal limiting membrane insertion versus standard internal limiting membrane peeling for macular hole retinal detachment in high myopia: one-year study. Graefes Arch Clin Exp Ophthalmol. 2018; 256(8):1387–1393.
10.1007/s00417-018-4046-1 PMID:29911271 > Crossref MedlineGoogle Scholar - 29.Kannan NB, Kohli P, Parida H, Adenuga OO, Ramasamy K. Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial. BMC Ophthalmol. 2018; 18(1):177.
10.1186/s12886-018-0826-y PMID:30029621 > Crossref MedlineGoogle Scholar - 30.Yuan J, Zhang LL, Lu YJ, Han MY, Yu AH, Cai XJ. Vitrectomy with internal limiting membrane peeling versus inverted internal limiting membrane flap technique for macular hole-induced retinal detachment: a systematic review of literature and meta-analysis. BMC Ophthalmol. 2017; 17(1):219.
10.1186/s12886-017-0619-8 PMID:29179705 > Crossref MedlineGoogle Scholar - 31.Chatziralli IP, Theodossiadis PG, Steel DHW. Internal Limiting Membrane Peeling In Macular Hole Surgery; Why, When, And How?Retina. 2018; 38(5):870–882.
10.1097/IAE.0000000000001959 PMID:29210940 > Crossref MedlineGoogle Scholar