A meta-analysis of vitrectomy with or without internal limiting membrane peeling for macular hole retinal detachment in the highly myopic eyes

Abstract

BackgroundTo evaluate the anatomical and visual outcomes by par plana vitrectomy with or without internal limiting membrane (ILM) peeling in highly myopic eyes with macular hole retinal detachment (MHRD).MethodsMEDLINE (Ovid, PubMed) and EMBASE were used for data collection up to September 30, 2015. The parameters of anatomical success, macular hole closure and improved best corrected visual acuity (BCVA) at or beyond 6 months after operation were assessed as the primary outcome measurement. The meta-analysis was performed with the fixed-effects model.ResultsSeven comparative analyses involving a total of 373 patients were included in the present meta-analysis. Statistically the pooled data showed significant relative risk (RR) in terms of primary reattachment between ILM peeling and non-peeling groups (RR, 1.19; 95 % CI, 1.04 to 1.36; P = 0.012). An effect favoring ILM peeling with regard to macular hole closure was also detected (RR, 1.71; 95 % CI, 1.20 to 2.43; P = 0.003). However, no statistically significant difference was found in the improved BCVA (logarithm of the minimum angle of resolution) at 6 months or more (95 % CI, −0.31 to 0.44; P = 0.738).ConclusionsThere is no proved benefit of postoperative visual improvement. However, the available evidences from this study suggested a superiority of ILM peeling over no peeling for myopic patients with MHRD.

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

“…While no proved efficacy has been shown for this additional step in epiretinal membrane surgery [32], ILM peeling provided encouraging outcomes when associated with retinal detachment surgery [33]. When it comes to MHRD in highly myopic eyes, ILM peeling ensured a high rate of primary reattachment and macular hole closure, compared to non- ILM peeling [34]. However, the management of MHRD in highly myopic eyes is challenging and several surgical approaches have been proposed, including the inverted ILM flap technique [17,18].…”

The management of macular hole retinal detachment and macular retinoschisis in pathological myopia; a UK collaborative study

“…All MHRD cases reported in this series are primary cases, thus final reattachment and closure rates are not available which would explain the 25% reported closure rates. ILM peeling in addition to peeling of pre-retinal structures for MHRD are generally considered important to reduce traction and create Chorioretinal atrophy n = 52 a n (%) n = 27 n (%) n = The management of macular hole retinal detachment and macular retinoschisis in pathological myopia greater retinal redundancy for the closure of the macular hole [29][30][31]. However, according to the literature available, macular hole closure rates using OCT monitoring have generally been low and varied from 10 to100% and retinal reattachment rates have varied from 43 to 92% [29,[32][33][34][35][36][37][38][39].…”

Evaluation of TGF-Beta 2 and VEGFα Gene Expression Levels in Epiretinal Membranes and Internal Limiting Membranes in the Course of Retinal Detachments, Proliferative Diabetic Retinopathy, Macular Holes, and Idiopathic Epiretinal Membranes

“…There are also results suggesting that ILM peeling may reduce retinal sensitivity and significantly increase the incidence of microscotomas [ 48 ]. A meta-analysis of vitrectomy with or without internal limiting membrane peeling for macular hole coexisting with retinal detachment in the highly myopic eyes done by Gao et al revealed no definite benefit of postoperative visual improvement [ 49 ].…”