Comparative study of vitrectomy combined with internal limiting membrane peeling and vitrectomy combined with internal limiting membrane flap covering in idiopathic macular hole treatment: a meta-analysis and systematic review

BACKGROUND To compare the therapeutic effects of vitrectomy (PPV) combined with the internal limiting membrane (ILM) flap coverage and PPV in combination with ILM peeling on the idiopathic large macular hole (MH), in order to better guide the treatment of large MH. METHODS Searching was conducted within PubMed, Web of Science, Embase, CNKI, and Wanfang databases, and relevant pieces of literature between 2010 and 2020 published in English or Chinese were included. RESULTS A total of 11 studies including 667 patients and 667 affected eyes were included; the effective rate of hole closure between the 2 groups were compared in 11 studies. Results exhibited 94.4% (286/303 eyes) in the test group (PPV combined with ILM flap coverage) and 85.8% (313/364 eyes) in the control group (PPV combined with ILM peeling) were closed. MH closure rates in the test group was superior to the control group [odds ratio (OR) =3.36, 95% confidence interval (CI): 1.88-6.01, P<0.001]. All 11 studies compared the preoperative and postoperative best corrected visual acuity (BCVA), with no significant difference in the preoperative test control group [standardized mean difference (SMD) =-0.18, 95% CI: -0.42 to 0.06, P=0.149]. The BCVA after surgery was better in the test group compared with the control group (SMD =-0.91, 95% CI: -1.43 to -0.40), P=0.001). DISCUSSION Compared with PPV combined with ILM peeling, PPV combined with ILM flap coverage can significantly improve the MH closure rate and postoperative BCVA.