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Takuya Nakajima, Takashi Ueta, Yasuo Noda; Effect of internal limiting membrane peeling adjunct to vitrectomy for macular edema: systematic review of literature and meta-analysis. Invest. Ophthalmol. Vis. Sci. 2014;55(13):1146.
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To evaluate the effect of internal limiting membrane (ILM) peeling adjunct to vitrectomy for macular edema due to diabetic retinopathy (DMR) or retinal vein occlusion (RVO)
Literature in Medline and Cochrane central register of controlled trials was systematically reviewed. Eligible studies were published retrospective or prospective studies comparing vitrectomy and vitrectomy with ILM peeling for DMR or RVO with no language restriction. Preoperative and postoperative logMAR visual acuity (VA), foveal thickness, and improvement in logMAR improvement were compared between vitrecomy (ILM on group) and vitrectomy with ILM peeling (ILM off group). Meta-analysis was conducted in fixed effects due to small heterogeneity among the included studies
Seven studies with 478 patients were included for analysis. Five and two studies were on DMR and RVO, respectively. A DMR study was prospective randomized trial and a DMR study was prospective case series. The other five were retrospective studies. At baseline, VA of ILM on group patients tended to be better than patients of ILM off group (mean difference; 0.04, 95%CI; -0.03-0.11, p=0.23). After 6 months, there was no difference in VA between the two groups (mean difference; 0.00, 95%CI;-0.06-0.05, p=0.89). Based on four studies with 212 patients that published improvement in VA change, VA tended to improve more in ILM on group than ILM off group (mean difference; 0.05, 95% CI; -0.14-0.03, p=0.21). There mean difference in preoperative (21.59 µm, 95%CI; -19.50-62.68,p=0.30) and postoperative (27.58 µm, 95%CI; -17.35-72.51, p=0.23) foveal thickness was similar between ILM on and ILM off groups
This meta-analysis showed almost the same surgical results between vitrectomy only and vitrectomy with ILM peeling. However, the paucity of prospective randomized study warrants the necessity of more evaluation in the future
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