Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

Abstract

Background: The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH).Methods: Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power.Results: This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = − 0.16, 95% CI = − 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = − 0.12 to 0.15; P = 0.86).Conclusion: Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.

Inverted internal limiting membrane flap technique in eyes with large idiopathic full-thickness macular hole: long-term functional and morphological outcomes

“…Although PPV, ILM peeling, and fluid-gas exchange still remain the standard surgical treatment for MH, several studies showed the superiority of the I-ILM flap technique. Especially, for large MH (diameter > 400 μm), higher closure rates and improvements in BCVA have been reported [ 26 – 28 , 35 , 36 , 51 ]. A meta-analysis of Gu and Qiu concluded that the I-ILM flap technique is an effective and safe method for the treatment of large MH, with high closure rates and good functional outcomes [ 26 ].…”

“…This technique resulted in an improvement of closure rates and visual function in large MH. Since then, several studies have reported the superiority of the I-ILM flap technique over ILM peeling in the treatment of large MH achieving better anatomical and functional outcomes [22][23][24][25][26][27][28]. Further studies have demonstrated the dependence of functional improvement on the postoperative integrity of the outer retinal layers.…”

Inverted ILM flap technique versus conventional ILM peeling for idiopathic large macular holes: A meta-analysis of randomized controlled trials

“…However, most of the included studies were either retrospective in nature or lacked a control arm. A recent meta-analysis indicated that inverted ILM flap was recommended for large MHs [13]. This meta-analysis included both retrospective studies and randomized controlled trials (RCTs), and did not analyze the type 1 closure rates.…”

Großes Makulaforamen – immer eine schlechte Prognose?

“…Der postoperative Visus scheint bei i‑ILM-Patienten kurzfristig schneller anzusteigen, im Langzeitverlauf scheint es jedoch keinen Visusunterschied zwischen Patienten, die mittels i‑ILM-Peeling operiert wurden, und Patienten, die mittels k‑ILM-Peeling operiert wurden, zu geben [ 1 , 16 ]. Diese Beobachtung konnte in der vorliegenden Arbeit dahingehend gestützt werden, dass sich der Visusunterschied zwischen den beiden Gruppen i‑ILM und k‑ILM im Beobachtungszeitraum verringerte, wie in Abb.…”