Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.
Ophthalmic Res. 2023;66(1):1071-1084. doi: 10.1159/000531510. Epub 2023 Aug 16.
Although internal limiting membrane (ILM) peeling facilitates macular hole (MH) closure and reduces late hole reopening, it brings some detrimental consequences to the retinal microstructure and functional outcomes. So far, previous studies have not reached a consensus on the optimal ILM peeling size.
The objective of this study was to evaluate the outcomes of different ILM peeling sizes for idiopathic MHs.
PubMed, Embase, Cochrane Library, Web of Science, CNKI, and WANFANG were searched until April 10, 2022. Studies in English or Chinese that compare the effects of two ILM peeling sizes (>2 disk diameters [DDs] vs. ≤2DD) for idiopathic MHs were included. The overall closure rate, postoperative best-corrected visual acuity (BCVA), type 1 closure, and adverse events were extracted. BCVA was converted to logarithm of the minimum angle of resolution (LogMAR).
Seven eligible studies (560 eyes) including 3 randomized clinical trials, 3 prospective trials, and one retrospective cohort were included. Pooled results showed a significantly better postoperative BCVA (mean difference = -0.16; 95% confidence interval [CI]: -0.27 to -0.04; LogMAR) and higher type 1 closure rate (risk ratio [RR] = 1.24; 95% CI: 1.08-1.43) in eyes with ILM peeling >2DD than those with peeling ≤2DD. No significant difference was found in overall closure rate and adverse events between the two groups. Subgroup analysis indicated that in MHs >400 μm, peeling >2DD helped obtain a better postoperative BCVA (mean difference = -0.17; 95% CI: -0.29 to -0.04; LogMAR) and higher frequency of type 1 closure (RR = 1.25; 95% CI: 1.03-1.51).
Peeling >2DD shares similar safety level with peeling ≤2DD and has a superiority of facilitating visual recovery. Larger ILM peeling may be more beneficial for large MHs.
尽管内界膜（ILM）剥除有助于黄斑裂孔（MH）闭合并减少晚期孔再开放，但它会对视网膜微观结构和功能结果产生一些不利影响。到目前为止，先前的研究尚未就最佳 ILM 剥除大小达成共识。
本研究旨在评估不同 ILM 剥除大小对特发性 MH 的治疗效果。
检索 PubMed、Embase、Cochrane 图书馆、Web of Science、中国知网（CNKI）和万方数据库，检索时间截至 2022 年 4 月 10 日。纳入比较两种 ILM 剥除大小（>2 个视盘直径[DD]与≤2DD）治疗特发性 MH 的效果的英文或中文研究。提取总体闭合率、术后最佳矫正视力（BCVA）、1 型闭合和不良事件。BCVA 转换为最小分辨角对数（LogMAR）。
纳入 7 项符合条件的研究（560 只眼），包括 3 项随机临床试验、3 项前瞻性试验和 1 项回顾性队列研究。汇总结果显示，ILM 剥除>2DD 组术后 BCVA （平均差异=-0.16；95%置信区间[CI]：-0.27 至-0.04；LogMAR）和 1 型闭合率（风险比[RR] = 1.24；95% CI：1.08-1.43）均显著优于剥除≤2DD 组。两组总体闭合率和不良事件无显著差异。亚组分析表明，在 MH >400μm 时，ILM 剥除>2DD 有助于获得更好的术后 BCVA（平均差异=-0.17；95% CI：-0.29 至-0.04；LogMAR）和更高的 1 型闭合频率（RR = 1.25；95% CI：1.03-1.51）。
剥除>2DD 与剥除≤2DD 具有相似的安全性，且在促进视力恢复方面具有优势。更大的 ILM 剥除可能对大 MH 更有益。
