Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China; and.
Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Retina. 2021 Jun 1;41(6):1143-1152. doi: 10.1097/IAE.0000000000003140.
To evaluate fovea-sparing internal limiting membrane (ILM) peeling in vitrectomy compared with traditional complete ILM peeling in vitreomacular interface diseases, including macular hole (MH), epiretinal membrane, macular foveoschisis, myopic traction maculopathy, and the like.
PubMed, EMBASE, Cochrane, CNKI Databases, and the ClinicalTrials.gov website (PROSPERO number CRD42020187401) were searched. Controlled trials comparing fovea-sparing with complete ILM peeling were included. Postoperative changes in best-corrected visual acuity, central retinal thickness in vitreomacular interface diseases, the incidence of MH closure in MH cases, full-thickness macular hole development in non-MH cases, and retinal reattachment in retinoschisis cases were extracted.
Fourteen studies (487 eyes) were eligible. Compared with complete ILM peeling, the fovea-sparing technique revealed significant improvement in best-corrected visual acuity ( logarithm of the minimum angle of resolution; weighted mean difference = -0.70; 95% confidence interval, -1.11 to -0.30), and a reduced incidence of full-thickness macular hole was noted in non-MH cases (risk ratios = 0.25; 95% confidence interval, 0.08-0.76). However, no significant differences in mean change in central retinal thickness, incidence of MH closure in MH cases, and retinal reattachment in retinoschisis cases were noted.
Based on current evidence, fovea-sparing ILM peeling significantly improve visual outcomes and decrease complications of full-thickness macular hole development in vitreomacular interface diseases.
评估与传统全内界膜（ILM）剥除相比，在玻璃体黄斑界面疾病（包括黄斑裂孔 [MH]、视网膜前膜、黄斑劈裂、近视牵拉性黄斑病变等）的玻璃体切除术中保留黄斑的内界膜（ILM）剥除术的效果。
检索 PubMed、EMBASE、Cochrane、中国知网数据库和 ClinicalTrials.gov 网站（PROSPERO 编号 CRD42020187401）。纳入比较保留黄斑与全 ILM 剥除的对照试验。提取玻璃体黄斑界面疾病术后最佳矫正视力、中央视网膜厚度的变化，MH 病例 MH 闭合的发生率，非 MH 病例全层黄斑孔的发展，以及视网膜劈裂病例视网膜复位的情况。
有 14 项研究（487 只眼）符合纳入标准。与全 ILM 剥除相比，保留黄斑的技术在最佳矫正视力方面有显著改善（最小角分辨率对数；加权均数差=-0.70；95%置信区间，-1.11 至-0.30），并且在非 MH 病例中全层黄斑孔的发生率降低（风险比=0.25；95%置信区间，0.08-0.76）。然而，中央视网膜厚度的平均变化、MH 病例 MH 闭合的发生率和视网膜劈裂病例视网膜复位的情况没有显著差异。
基于现有证据，保留黄斑的 ILM 剥除术可显著改善玻璃体黄斑界面疾病的视力结果，并降低全层黄斑孔发展的并发症风险。
Zotero 插件
