Impact of internal limiting membrane peeling on macular hole reopening: An analysis of pooled data

Abstract

 

Purpose

 

To assess the literature regarding macular hole reopening rates stratified by whether or not the internal limiting membrane (ILM) was peeled during vitrectomy surgery.

 

Methods

 

A comprehensive literature search using the National Library of Medicine PubMed interface identified publications reporting on macular hole reopenings among previously surgically closed idiopathic macular holes. The minimum mean follow up period for reports to be included in this study was 12 months. Categorical data were assessed using Fisher’s exact test. Analysis was divided into eyes that underwent vitrectomy with and without ILM peeling. The primary outcome parameter was the proportion of macular hole reopenings amongst previously closed holes between the two groups. Secondary outcome parameters included duration from initial surgery to hole reopening, pre-operative, and post-operative best-corrected correct visual acuities (BCVA) amongst the non-ILM peeling and ILM peeling groups.

 

Results

 

A total of 50 publications reporting on 5480 eyes met inclusion criteria, and were assessed through the analysis of pooled data. The reopening rate without ILM peeling was 7.12% (125 of 1756 eyes), compared to 1.18% (44 of 3724 eyes) with ILM peeling (Odds ratio: 0.16; 95% CI: 0.11 - 0.22; Fisher’s exact test: p<0.0001). There were no other identifiable associations or risk factors for reopening.

 

Conclusions

 

The results of this pooled data analysis support the concept that ILM peeling during macular hole surgery significantly reduces the likelihood of macular hole reopening.

 

 

Figure 1. Funnel plot analysis to assess publication bias for studies without internal limiting membrane peeling is shown.

 

 

Figure 2. Funnel plot analysis to assess publication bias for studies with internal limiting membrane peeling is shown.

 

Keywords: 586 macular holes • 762 vitreoretinal surgery