Meta-analysis Of Internal Limiting Membrane Peeling Versus No Peeling For Idiopathic Macular Hole Surgery

objective: To evaluate the safety and efficacy of internal limiting membrane peelingfor idiopathic macular hole surgery。Methods: With no date, published status or language restrictions in the electronicsearches for trials, two researchers respectively searched “macular hole”,“internal limitingmembrane peel”,“internal limiting membrane” in the Pubmed, Ovid-Medline, CocolineLibrary, Wanfang database, Weipu Chinese Academic Journal and CNKI detabase andcollected papers about idiopathic macular hole vitrectomy surgery with and without internallimiting membrane peeling. The relevant ophthalmologic magazines, the proceedings ofacademic meeting and the references of related reviews were inspected by hand. Jadad scalewas used to evaluate the quality of the included studies. Meta-analysis was performed forclosed rate, visual outcome and postoperative complications.Result：Finally,23pieces of paper about internal limiting membrane peeling invitrectomy among idiopathic macular hole were included.5pieces were randomizedcontrolled trials, while the other18cases were non-randomized controlled trials. Firstheterogeneity analysis was performed for the included studies. if the homogeneity was existbetween studies, the fixed effect model was choosed in Revman5.0software. If not, therandom effects model was choosed.(1) Combined results of postoperative closed rate:ILMP can improve the postoperative closed rate in IMH (OR=4.78,95%CI[2.94,7.75]),the results was statistically significant. Stratified analysis was performed for three stage ofIMH, ILMP can improve postoperative closed rate in stage2IMH (OR=6.21,95%CI[2.59,14.90]), stage3IMH (OR=3.89,95%CI[2.50,6.05]) and stage4IMH (OR=2.77,95%CI[1.77,4.34]), the results were statistically significant.(2) Combined results ofpostoperative visual outcome: visual acuity improved rate in ILMP group was higher thanNO-ILMP group(OR=3.37,95%CI[1.74,6.51]). visual acuity improved rate in closed holehad the same rate between the two groups (OR=1.64,95%CI[0.85,3.18]), the result wasnot statistically significant. The combined result of postoperative BCVA in ILMP (SMD=-0.51,95%CI[-0.73,-0.29]) was higher than the NO-ILMP group, the result was notstatistically significant.(3) Postoperative complications findings of this study: combined results suggest that the reopening rate of ILMP group was lower than the NO-ILMP group(OR=0.05,95%CI[0.02,0.16]). retinal detachment incidence (OR=0.88,95%CI [0.50,1.56]), increased IOP incidence (OR=0.92,95%CI[0.50,1.70]) and retinal tearincidenceare (OR, merge=2.07,95%CI[0.85,5.02]) were not statistically significant.Conclusion:Compareing with NO-ILMP, ILMP was associated with significantlyhigher postoperative anatomical closed rate, visual acuity improved rate and BCVA in IMHand lower reopening rate. While ILMP does not significantly improve visual acuity amonganatomical successful holes compareing with NO-ILMP. The occurrence of thepostoperative retinal detachment, retinal tear and increased IOP were not statisticallysignificant between ILMP and NO-ILMP. Due to heterogeneity between studies,low-quality research and the presence of potential publication bias, it is required to carry outa series of high-quality research on its safety and efficacy of a more comprehensiveevaluation.