Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole
Abstract Background Macular holes (MHs) are a leading cause of visual impairment and blindness worldwide defined as a partial or full thickness anatomical defect in the fovea of the retina. ILM peeling is an effective surgical procedure to repair the defect. However, this approach lacks efficacy for...
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2025-04-01
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| Online Access: | https://doi.org/10.1186/s12886-025-04011-0 |
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| author | Syed Muhammad Muneeb Akhtar Syed Zia Saleem Syed Ali Asad Rizvi Areeba Fareed Munazza Mumtaz Shiza Saleem Anusha Bai Afsana Ansari Shaik Robert Kirchoff Muhammad Sohaib Asghar |
| author_facet | Syed Muhammad Muneeb Akhtar Syed Zia Saleem Syed Ali Asad Rizvi Areeba Fareed Munazza Mumtaz Shiza Saleem Anusha Bai Afsana Ansari Shaik Robert Kirchoff Muhammad Sohaib Asghar |
| author_sort | Syed Muhammad Muneeb Akhtar |
| collection | DOAJ |
| description | Abstract Background Macular holes (MHs) are a leading cause of visual impairment and blindness worldwide defined as a partial or full thickness anatomical defect in the fovea of the retina. ILM peeling is an effective surgical procedure to repair the defect. However, this approach lacks efficacy for larger macular holes. ILM flap is a novel technique with demonstrated efficacy for repair of larger defects. Objective This systematic review and meta-analysis aims to compare the effectiveness of these two techniques in treating any size and type of MH. Methods A comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were MH closure rate and postoperative VA. The statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Pooled odds ratios (ORs), mean differences (MD), and 95% confidence intervals (CIs) were calculated. All statistical analyses were performed using R Statistical Software and meta package v4.17-0. Results A total of thirty-two studies, comprising nine RCTs and twenty three retrospective studies were included in this meta-analysis, which involved 1220 eyes in the ILM flap group and 1277 eyes in the ILM peeling group. The overall MH closure rate significantly favored ILM flap technique (OR = 2.47, CI = 1.58 to 3.87; P < 0.001; I²= 30%). The overall pooled result for postoperative VA, no significant difference was observed between the two surgical methods. However, it favored ILM flap technique on subgroup analysis based on study type and MH size specifically in the RCTS with macular hole size > 400 μm (MD = -0.13, 95% CI = -0.17 to -0.08, p < 0.01; I2 = 13%), as well as on subgrouping based on follow-up duration (MD = -0.11, 95% CI = -0.14 to -0.08, p < 0.01; I2 = 25%). Conclusion ILM flap technique resulted in significantly better closure rate with all sizes of MHs, coupled with improved visual acuity in larger MHs and with follow-up duration. |
| format | Article |
| id | doaj-art-0fafdf8de6bf4083a54817a4fe1e3ab3 |
| institution | OA Journals |
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| publishDate | 2025-04-01 |
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| series | BMC Ophthalmology |
| spelling | doaj-art-0fafdf8de6bf4083a54817a4fe1e3ab32025-08-20T02:11:46ZengBMCBMC Ophthalmology1471-24152025-04-0125111510.1186/s12886-025-04011-0Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular holeSyed Muhammad Muneeb Akhtar0Syed Zia Saleem1Syed Ali Asad Rizvi2Areeba Fareed3Munazza Mumtaz4Shiza Saleem5Anusha Bai6Afsana Ansari Shaik7Robert Kirchoff8Muhammad Sohaib Asghar9Department of Medicine, Dow University of Health SciencesDepartment of Medicine, Dow University of Health SciencesDepartment of Medicine, Dow University of Health SciencesDepartment of Medicine, Karachi Medical and Dental CollegeDr. Ruth K. M. Pfau Civil HospitalDepartment of Medicine, Hamdard College of Medicine & DentistryDepartment of Medicine, Liaquat National Hospital & Medical CollegeMayo ClinicDepartment of Internal Medicine, Mayo ClinicAdventHealthAbstract Background Macular holes (MHs) are a leading cause of visual impairment and blindness worldwide defined as a partial or full thickness anatomical defect in the fovea of the retina. ILM peeling is an effective surgical procedure to repair the defect. However, this approach lacks efficacy for larger macular holes. ILM flap is a novel technique with demonstrated efficacy for repair of larger defects. Objective This systematic review and meta-analysis aims to compare the effectiveness of these two techniques in treating any size and type of MH. Methods A comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were MH closure rate and postoperative VA. The statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Pooled odds ratios (ORs), mean differences (MD), and 95% confidence intervals (CIs) were calculated. All statistical analyses were performed using R Statistical Software and meta package v4.17-0. Results A total of thirty-two studies, comprising nine RCTs and twenty three retrospective studies were included in this meta-analysis, which involved 1220 eyes in the ILM flap group and 1277 eyes in the ILM peeling group. The overall MH closure rate significantly favored ILM flap technique (OR = 2.47, CI = 1.58 to 3.87; P < 0.001; I²= 30%). The overall pooled result for postoperative VA, no significant difference was observed between the two surgical methods. However, it favored ILM flap technique on subgroup analysis based on study type and MH size specifically in the RCTS with macular hole size > 400 μm (MD = -0.13, 95% CI = -0.17 to -0.08, p < 0.01; I2 = 13%), as well as on subgrouping based on follow-up duration (MD = -0.11, 95% CI = -0.14 to -0.08, p < 0.01; I2 = 25%). Conclusion ILM flap technique resulted in significantly better closure rate with all sizes of MHs, coupled with improved visual acuity in larger MHs and with follow-up duration.https://doi.org/10.1186/s12886-025-04011-0Inverted internal limiting membrane flap techniqueInternal limiting membrane peelingMacular holeMeta-analysis |
| spellingShingle | Syed Muhammad Muneeb Akhtar Syed Zia Saleem Syed Ali Asad Rizvi Areeba Fareed Munazza Mumtaz Shiza Saleem Anusha Bai Afsana Ansari Shaik Robert Kirchoff Muhammad Sohaib Asghar Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole BMC Ophthalmology Inverted internal limiting membrane flap technique Internal limiting membrane peeling Macular hole Meta-analysis |
| title | Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole |
| title_full | Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole |
| title_fullStr | Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole |
| title_full_unstemmed | Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole |
| title_short | Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole |
| title_sort | critical analysis of macular hole repair techniques a comprehensive systematic review and meta analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole |
| topic | Inverted internal limiting membrane flap technique Internal limiting membrane peeling Macular hole Meta-analysis |
| url | https://doi.org/10.1186/s12886-025-04011-0 |
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