The Effect Of Internal Limiting Membrane Peeling During Vitrectomy For Diabetic Macular Edema:Systematic Review And Meta-analysis

[Objective]To evaluate the effect of PPV and PPV combined with internal limiting membrane peeling(ILMP)for diabetic macular edema.[Methods]Searches were conducted in PUBMED,MEDLINE,EMBASE,CNKI,Cochrane library,CBM and etc.Studies that met the inclusion criteria were selected for further analysis.The Jadad score was used for quality and comparability assessment,and the meta-analysis was performed using Revman 5.3 software.[Results]Six studies in the literature were selected for meta-analysis,including a total of 857 eyes: one group had undergone pars plana vitrectomy(PPV)alone(507 eyes)and the other group had undergone internal limiting membrane(ILM)peeling during pars plana vitrectomy(PPV)(350 eyes).The results of the meta-analysis showed the following:(1)Best corrected visual acuity(BCVA): There was no significant difference in baseline VA between the two groups(WMD=-0.01,95% CI:-0.09 ~ 0.07,P=0.83>0.05).There was no significant difference in postoperative VA between the two groups at the postsurgical follow-up after 6 months(WMD=-0.01,95% CI:-0.09 ~ 0.07,P=0.80>0.05).There was no significant difference in postoperative VA between the two groups at the postsurgical follow-up after 12 months(WMD=0.03,95% CI:-0.04 ~ 0.11,P=0.39>0.05).There was no significant difference in change in VA between the two groups at the postsurgical followup after 6 months(WMD=0.04,95% CI:0.00 ~ 0.08,P=0.05).There was no significant difference in change in VA between the two groups at the postsurgical follow-up after 12 months(WMD=0.03,95% CI:-0.02~ 0.07,P=0.22>0.05).(2)Central macular thickness: There was no significant difference in baseline central macular thickness between the two groups(WMD=29.23,95% CI:-18.60 ~ 77.07,P=0.23>0.05).There was no significant difference in central macular thickness between the two groups at the postsurgical follow-up after 6 months(WMD=-31.6,95% CI:-207.22 ~ 144.02,P=0.72>0.05).There was no significant difference in change in central macular thickness between the two groups at the postsurgical follow-up after 6 months(WMD=87.7,95% CI:-24.87~ 200.27,P=0.13>0.05).[Conclusion]Compared with the group that underwent pars plana vitrectomy(PPV)alone,the group that underwent pars plana vitrectomy(PPV)with ILM peeling has no advantages in improving the BCVA or reducing central macular thickness in curing diabetic macular edema(DME).More clinical trials are still needed to confirm our results.