Vitrectomy With Inverted Internal Limiting Membrane Flap For Macular Hole Retinal Detachment In High Myopia:A Meta-analysis

Objective To evaluate the effect of vitrectomy with inverted internal limiting membrane(ILM)flap for the treatment of macular hole retinal detachment(MHRD)in high myopia compared with that of ILM peeling.Methods Pubmed,Web of Science,Embase,Medline,Wanfang and CNKI were systematically reviewed.Literatures were selected and included according to the inclusion and exclusion criteria,and then literature quality evaluation was performed.The primary outcome parameters were the MH closure rate,retinal reattachment rate,and postoperative BCVA(best-corrected visual acuity).Secondary outcome parameters included intraoperative or postoperative complications.Softwares of Review Manager 5.3 and Stata 14.0 were used for statistical analysis.Results Seven retrospective comparative studies including 228 eyes were selected.(1)No significant difference was detected in either postoperative BCVA(MD-0.07,95% CI-0.17 to 0.03,P=0.16)or the improvement in postoperative BCVA(MD-0.17,95% CI-0.50 to 0.16,P=0.32)between the ILM flap group and ILM peeling group.The retinal reattachment rate using inverted ILM flap was not significantly different from that using ILM peeling(OR(odds ratio)2.24,95% CI 0.75 to 6.73,P=0.15).The MH closure rate was higher with inverted ILM flap than with ILM peeling(OR 11.86,95% CI 5.65 to 24.92,P<0.00001).(2)There was no significant difference in intraoperative or postoperative complications,including concomitant cataract rate(OR 1.22,95% CI 0.42 to 3.58,P=0.71).(3)In the subgroup analysis,whether using BBG(brilliant blue G)or ICG(indocyanine green)staining ILM,there was no statistical difference in either postoperative BCVA(P=0.07,P=0.56)or the retinal reattachment rate(P=0.50,P=0.16)between the ILM flap group and ILM peeling group.And the MH closure rate was still significantly higher in the ILM flap group(P<0.0001,P<0.00001).(4)The subgroup analysis of the tamponades revealed that whether it was filled with gas or filled with silicone oil,no significant difference was detected in either postoperative BCVA(P=0.62,P=0.48)or the retinal reattachment rate(P=0.11,P=0.38)between the two surgery groups and the MH closure rate was also significantly higher in the inverted ILM flap group(P<0.00001,P=0.005).Conclusion The inverted ILM flap technique could contribute to a higher MH closure rate than ILM peeling,but visual improvement was similar.Both surgical methods could obtain a high retinal reattachment rate with fewer intraoperative and postoperative complications.