Zhang Ruiheng, Fang Yan-Cheng, Shi Xuhan, Wu Haotian, Yu Chuyao, Li Yitong, Zhou Wenda, Li Heyan, Zhang Chuan, Zhou Yan-Feng, Dong Li, Wei Wenbin
Beijing Tongren Eye Center, Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology & Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Hospital, Capital Medical University, 1 Dong Jiao Min Lane, Beijing, 100730, China.
Department of Ophthalmology, First Affiliated Hospital of Anhui Medical University, No.218, Jixi Road, Shushan District, Hefei, Anhui, China.
Heliyon. 2024 Aug 20;10(17):e36588. doi: 10.1016/j.heliyon.2024.e36588. eCollection 2024 Sep 15.
Primary surgery failure of macular holes causes poor visual acuity outcomes. Several studies indicate that small-medium idiopathic full-thickness macular holes (iFTMH) have consistent and high anatomical closure rates after vitrectomy and internal limiting membrane (ILM) peeling, regardless of iFTMH diameters. However, there is no systematic analysis examining the relationship between iFTMH diameters and anatomical closure rates.
In this systematic review and meta-regression, we searched PubMed, Embase, and Web of Science databases on October 24th, 2022. We included studies regarding iFTMH, with ILM peeling/inverted flap technique, long-lasting gas tamponade, and face-down position after surgery. Univariable meta-regression with a restricted cubic spline model and component-plus-residual plot after covariables adjustment were used to explore non-linear association.
A total of 7257 participants from 19 randomized controlled trials and 49 observational studies were included in this meta-analysis. In ILM peeling group, every 100-μm increment in diameter was associated with a 3.8 % (95 % confidence interval [CI], 1.8%-5.7 %, < 0.001) relatively lower anatomical closure rate. Yet, among studies using the inverted flap technique, baseline iFTMH diameter was not associated with a lower anatomical closure rate (0.2 %, 95%CI, -4.2 %-4.5 %, > 0.9). The restricted cubic spline model and component-plus-residual plot controlling for age, sex, and symptom duration prior to surgery showed no evident non-linearity in both surgical techniques.
The iFTMH diameter is linear and inversely associated with the anatomical closure rate after the ILM peeling technique, but not with the inverted flap technique. The present study supports the use of advanced techniques, e.g., inverted flap technique, in small-medium iFTMH to improve anatomical closure rates.
黄斑裂孔一期手术失败会导致视力预后不佳。多项研究表明，无论特发性全层黄斑裂孔（iFTMH）直径大小，玻璃体切割联合内界膜（ILM）剥除术后，中小尺寸的iFTMH具有一致且较高的解剖学闭合率。然而，尚无系统分析研究iFTMH直径与解剖学闭合率之间的关系。
在这项系统评价和meta回归分析中，我们于2022年10月24日检索了PubMed、Embase和Web of Science数据库。我们纳入了有关iFTMH、采用ILM剥除/翻转瓣技术、长效气体填塞以及术后俯卧位的研究。使用受限立方样条模型进行单变量meta回归分析，并在调整协变量后绘制成分加残差图，以探索非线性关联。
本meta分析共纳入了来自19项随机对照试验和49项观察性研究的7257名参与者。在ILM剥除组中，直径每增加100μm，解剖学闭合率相对降低3.8%（95%置信区间[CI]，1.8%-5.7%，P<0.001）。然而，在采用翻转瓣技术的研究中，基线iFTMH直径与较低的解剖学闭合率无关（0.2%，95%CI，-4.2%-4.5%，P>0.9）。在控制年龄、性别和术前症状持续时间的情况下，受限立方样条模型和成分加残差图显示两种手术技术均无明显的非线性关系。
iFTMH直径与ILM剥除技术后的解剖学闭合率呈线性负相关，但与翻转瓣技术无关。本研究支持在中小尺寸的iFTMH中使用先进技术，如翻转瓣技术，以提高解剖学闭合率。
