Inverted Internal Limiting Membrane Flap vs. ILM Peeling for <400 µm Macular Hole: A Meta-Analysis and Systematic Review

Abstract

Pingping Li*, Lu Li and Jianhua Wu

Inverted Internal Limiting Membrane (ILM) flap technique was developed to achieve Macular Hole (MH) closure in large MH. But the efficacy of small holes has been controversial. The aim of this study was to compare the anatomical and visual outcomes of vitrectomy (PPV) combined with the inverted ILM flap and ILM peeling in small and medium size MHs. Search relevant literature within PubMed, Web of Science, Embase, Cochrane library, and CNKI from inception through October 2022 in English or Chinese. Only case-control studies were included. Heterogeneity, publication bias, and sensitivity analysis were conducted to ensure the statistical power. This meta-analysis included six studies involving 299 eyes, 3 randomized control trials, and 3 retrospective studies. Summarizing data displayed that the MH closure rate was not different between the inverted ILM flap group and peeling group (Odds Ratio (OR) =0.29?95% Confidence Interval (CI): 0.04 ~ 1.96, P=0.33). Whereas there was no significant difference in visual acuity improvement, the integrity of the External Limiting Membrane (ELM) and the Ellipsoid Zone (EZ) in 3 months or 12 months after surgery between the two groups. Therefore inverted ILM flap and ILM peeling are both effective treatments for <400 μm MHs, and are associated with comparable outcomes as well as don’t damage the integrity of the retina.