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

Abstract

BackgroundInternal 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.ObjectiveTo assess the efficacy of ILM peeling versus non-ILM peeling during vitrectomy for RRD by a systematic review and meta-analysis of published studies.MethodsPubMed, 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.ResultsNine 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).ConclusionILM 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.

Fluocinolone acetonide vitreous insert for chronic diabetic macular oedema: a systematic review with meta-analysis of real-world experience

“…All these support a good quality level of evidence. Moreover, a meta-analysis has more accurate confidence and higher power than a single report 33 , 34 .…”

Primary vitrectomy for degenerative and tractional lamellar macular holes: A systematic review and meta-analysis

“…using the Newcastle–Ottawa Quality Assessment Scale (NOS), which evaluates patient selection, comparability of degenerative LMH group and tractional LMH group, and outcome [ 14 ]. The risk of bias for each included study was categorized as high when the NOS score was < 6, and low-to-moderate when ≥6 [ 15 ]. Publication bias was evaluated by examination of the funnel plot for evidence of asymmetry and the Egger regression test.…”

Evaluation of primary internal limiting membrane peeling in cases with rhegmatogenous retinal detachment

“…We also excluded eyes with fovea-sparing RRDs to avoid any potential complications of performing ILM peeling on a non-diseased macula. A recent meta-analysis of studies comparing ILM peeling versus no peeling during PPV for RRD found the incidence of postoperative macular ERM formation to be significantly lower in patients who had ILM peeling, but this bared no significant effect on postoperative visual outcomes [3].…”

“…ERMs may develop after successful vitrectomy for repair of rhegmatogenous retinal detachment (RRD) with an incidence that varies from 6 to 48% according to published literature [3]. Risk factors for post-PPV ERM development include multiple, large or posterior retinal breaks, as well as a longer duration of macular detachment [4,5].…”