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Retina (Philadelphia, Pa.) Jun 2021To evaluate fovea-sparing internal limiting membrane (ILM) peeling in vitrectomy compared with traditional complete ILM peeling in vitreomacular interface diseases,... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate fovea-sparing internal limiting membrane (ILM) peeling in vitrectomy compared with traditional complete ILM peeling in vitreomacular interface diseases, including macular hole (MH), epiretinal membrane, macular foveoschisis, myopic traction maculopathy, and the like.
METHODS
PubMed, EMBASE, Cochrane, CNKI Databases, and the ClinicalTrials.gov website (PROSPERO number CRD42020187401) were searched. Controlled trials comparing fovea-sparing with complete ILM peeling were included. Postoperative changes in best-corrected visual acuity, central retinal thickness in vitreomacular interface diseases, the incidence of MH closure in MH cases, full-thickness macular hole development in non-MH cases, and retinal reattachment in retinoschisis cases were extracted.
RESULTS
Fourteen studies (487 eyes) were eligible. Compared with complete ILM peeling, the fovea-sparing technique revealed significant improvement in best-corrected visual acuity ( logarithm of the minimum angle of resolution; weighted mean difference = -0.70; 95% confidence interval, -1.11 to -0.30), and a reduced incidence of full-thickness macular hole was noted in non-MH cases (risk ratios = 0.25; 95% confidence interval, 0.08-0.76). However, no significant differences in mean change in central retinal thickness, incidence of MH closure in MH cases, and retinal reattachment in retinoschisis cases were noted.
CONCLUSION
Based on current evidence, fovea-sparing ILM peeling significantly improve visual outcomes and decrease complications of full-thickness macular hole development in vitreomacular interface diseases.
Topics: Basement Membrane; Fovea Centralis; Humans; Retinal Diseases; Tomography, Optical Coherence; Visual Acuity; Vitrectomy
PubMed: 34001832
DOI: 10.1097/IAE.0000000000003140 -
Ophthalmic Research 2021Myopic traction maculopathy (MTM) is a major cause of impaired vision in eyes with high myopia, which is characterized by retinal thickening, retinoschisis, lamellar... (Comparative Study)
Comparative Study Meta-Analysis
INTRODUCTION
Myopic traction maculopathy (MTM) is a major cause of impaired vision in eyes with high myopia, which is characterized by retinal thickening, retinoschisis, lamellar macular hole (MH), and foveal retinal detachment. Pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane peeling (ILMP) has been developed to theoretically prevent postoperative MH formation and improve best-corrected visual acuity (BCVA) gain for MTM compared with the complete ILMP. However, in previous studies, the anatomic and visual outcomes still remain uncertain and controversial.
OBJECTIVES
The aim of this study was to evaluate the anatomic and visual outcomes of vitrectomy with fovea-sparing ILMP for the treatment of MTM compared with complete ILMP.
METHODS
Articles from PubMed, EMBASE, Web of Science, and Cochrane Library were systematically retrieved. The main outcomes were the rate of a postoperative MH and visual improvement of BCVA (converted to logarithm of the minimum angle of resolution [logMAR]). The secondary outcomes were the proportion of patients with visual improvement, the proportion of anatomic success, preoperative and postoperative BCVA, preoperative and postoperative central fovea thickness, and time to anatomic resolution.
RESULTS
There was a higher rate of postoperative MH formation (odds ratio [OR] 5.64; 95% confidence interval [CI]: 1.72-18.44; p = 0.004) and less improvement of BCVA in logMAR (mean difference [MD] -0.09; 95% CI: -0.18 to 0.00; p = 0.04) in the complete ILMP group. However, postoperative BCVA (MD 0.14; 95% CI: 0.00-0.27; p = 0.05), the proportion of patients with visual improvement (OR 0.39; 95% CI: 0.15-1.02; p = 0.05), postoperative central foveal thickness (MD -10.02; 95% CI: -24.4 to 4.36; p = 0.17), the rate of anatomic success (MD 0.39; 95% CI: 0.15-1.03; p = 0.06), and time to resolution (MD -1.65; 95% CI: -3.66 to 0.36; p = 0.11) showed no significant differences.
CONCLUSION
PPV combined with the fovea-sparing ILMP could contribute to a lower MH formation rate and more improvement of BCVA in logMAR than PPV combined with complete ILMP.
Topics: Basement Membrane; Humans; Macular Degeneration; Myopia, Degenerative; Retinal Perforations; Retrospective Studies; Tomography, Optical Coherence; Traction; Visual Acuity; Vitrectomy
PubMed: 34425571
DOI: 10.1159/000519021 -
Ophthalmology. Retina Jul 2021The effectiveness of fovea-sparing (FS) peeling of internal limiting membrane (ILM) to treat myopic foveoschisis (MF) has not been understood fully. The present... (Meta-Analysis)
Meta-Analysis
TOPIC
The effectiveness of fovea-sparing (FS) peeling of internal limiting membrane (ILM) to treat myopic foveoschisis (MF) has not been understood fully. The present meta-analysis aimed to compare postoperative visual and anatomic outcomes between FS peeling and total peeling (TP) of ILM in pars plana vitrectomy for the treatment of MF.
CLINICAL RELEVANCE
Postoperative macular hole (MH) development is not uncommon and is a serious complication after surgery for MF, with poor visual prognosis. Fovea-sparing peeling of ILM is expected to reduce the risk of postoperative MH; however, no statistically significant evidence exists to prove this hypothesis. In addition, its effect on postoperative visual acuity has not been clear.
METHODS
MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were reviewed systematically, and studies that compared FS with total ILM peeling in MF surgery were retrieved. The protocol was registered in International Prospective Register of Systematic Reviews (identifier, CRD42020201675). Primary outcome measures were the postoperative best-corrected visual acuity (BCVA) and frequency of postoperative MH development. Certainty of evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation system.
RESULTS
Eight studies with 300 eyes from 289 patients were included. All studies were nonrandomized and observational. The postoperative BCVA was significantly better in eyes treated with FS (mean difference [MD], -0.15 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], -0.24 to -0.05 logMAR; P = 0.002). The risk of postoperative MH was significantly lower in the FS group (odds ratio, 0.19; 95% CI, 0.06-0.56; P = 0.003). No significant difference was found in postoperative central foveal thickness (MD, 12.59 μm; 95% CI, -2.8 to 28.0 μm; P = 0.11). The certainty of evidence regarding lower frequency of postoperative MH after FS peeling was considered moderate, whereas the certainty regarding better postoperative BCVA after FS peeling was judged to be low.
DISCUSSION
Fovea-sparing peeling may contribute to better visual acuity outcome and lower risk of postoperative MH development in eyes with MF.
Topics: Basement Membrane; Descemet Stripping Endothelial Keratoplasty; Fovea Centralis; Humans; Myopia; Retinoschisis
PubMed: 33307217
DOI: 10.1016/j.oret.2020.10.010