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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 -
PloS One 2021To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies. (Meta-Analysis)
Meta-Analysis
PURPOSE
To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies.
METHODS
PubMed, Medline and Embase databases were searched up to May 2020. Included cohorts were divided into three groups: degenerative LMH group, lamellar hole associated epiretinal proliferation (LHEP) group and tractional LMH group. LHEP is likely to be associated with degenerative LMHs, but less commonly could be associated with mixed LMHs. To reduce risk of possible misclassification bias, eyes with LHEP which could not have been precisely classified by the authors, were included into the LHEP group. The primary outcome was to investigate the visual change following primary vitrectomy in the degenerative LMH and LHEP group versus the tractional LMH group. A sensitivity analysis excluding the LHEP group was also performed on the primary outcome. Mean difference (MD) in best corrected visual acuity between baseline and post-treatment was calculated, along with 95% confidence interval (CI). Rate of incidence of post-operative full-thickness macular hole (FTMH) was assessed as secondary outcome.
RESULTS
Thirteen studies were included. Pooled analyses including all groups showed a significant visual improvement following vitrectomy (pre-post MD = -0.17;95%CI = -0.22,-0.12;p<0.001), with no difference in visual improvement between the degenerative LMH and LHEP group and the tractional LMH group. The sensitivity analysis excluding LHEP group confirmed no difference in visual change between the degenerative LMH group (pre-post MD = -0.18;95%CI = -0.24,-0.12;p<0.001) and the tractional LMH group (MD = -0.16;95%CI = -0.26,-0.07;p<0.001). The incidence rate of post-operative FTMH was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002).
CONCLUSION
Primary vitrectomy for LMH ensured a favorable visual outcome, with no difference in visual gain between degenerative and tractional LMHs. However, a higher incidence of post-operative FTMHs was found in eyes with the degenerative LMH subtype.
Topics: Humans; Retinal Perforations; Visual Acuity; Vitrectomy
PubMed: 33667237
DOI: 10.1371/journal.pone.0246667 -
Acta Ophthalmologica Nov 2021To evaluate the basic characteristics of optic disc pit maculopathy (ODPM) and the efficacies of pars plana vitrectomy (PPV) treatment with different adjunctive... (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the basic characteristics of optic disc pit maculopathy (ODPM) and the efficacies of pars plana vitrectomy (PPV) treatment with different adjunctive strategies.
METHODS
The databases PubMed, EMBASE and Ovid up to April 2020 were searched to identify relevant studies. Statistical analyses were conducted with R software version 3.6.3.
RESULTS
Fifty-nine studies were eventually included for different aspects of statistical analyses. The pooling results suggest the general incidence of maculopathy in optic disc pit (ODP) is 51%, and the rate of serous macular detachment and retinoschisis is 49% and 58%, respectively. The incidence of sub-retinal fluid (SRF) only is 10%, intra-retinal retinal (IRF) fluid only is 14%, and SRF plus IRF is 69%. A lamellar macular hole (LMH) is present in 53% of cases, and 58% have communication between the macula with the pit. The incidence of posterior vitreous detachment (PVD), vitreo-papillary traction and vitreomacular traction (VMT) is 7%, 28% and 13%, respectively. Besides, the rate of complete anatomic success and visual improvement after PPV are both around 85%. Subgroup analysis reveals the anatomic, and visual success rates of PPV alone are 89% and 100%, respectively. Gas tamponade, laser or internal limiting membrane peeling (ILMP) during vitrectomy are less promising, while PPV with ILM flap stuffing could achieve better outcomes than cases without it.
CONCLUSION
Optic disc pit-associated maculopathy has different fundus characteristics. Based on the current evidence, PPV is effective for ODPM, and the combined application of gas tamponade, laser and ILMP should be used with caution.
Topics: Eye Abnormalities; Humans; Macular Degeneration; Optic Disk; Tomography, Optical Coherence; Vitrectomy
PubMed: 33421324
DOI: 10.1111/aos.14730 -
International Journal of Ophthalmology 2020To compare the outcomes of four adjuvants used for internal limiting membrane (ILM) peeling in macular hole surgery, including indocyanine green (ICG), brilliant blue G...
AIM
To compare the outcomes of four adjuvants used for internal limiting membrane (ILM) peeling in macular hole surgery, including indocyanine green (ICG), brilliant blue G (BBG), triamcinolone (TA) and trypan blue (TB), through systematic review and random-effects Bayesian network Meta-analysis.
METHODS
PubMed, Cochrane library databases and Web of Science were searched until August 2018 for clinical trials comparing the above four adjuvants. ORs for postoperative best corrected visual acuity (BCVA) improvement and primary macular hole closure rates were compared between the different adjuvants.
RESULTS
Twenty-seven eligible articles were included. For postoperative BCVA improvement, results of BBG-assisted peeling were significantly more favorable than those of ICG (WMD 0.08, 95% credible interval 0.01-0.16) and TA ranked highest. No significant differences were found between any other two groups in postoperative BCVA improvement. For postoperative primary macular hole closure rates, BBG ranked highest. However, no significant differences were shown between any two groups.
CONCLUSION
TA and BBG are the optimum adjuvants for achieving postoperative BCVA improvement macular hole surgery with adjuvant-assisted ILM peeling. Among all adjuvants, the use of BBG is associated with the highest postoperative macular hole closure rate.
PubMed: 32309187
DOI: 10.18240/ijo.2020.03.17 -
BMC Ophthalmology Jan 2020The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane... (Comparative Study)
Comparative Study Meta-Analysis
Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis.
BACKGROUND
The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH).
METHODS
Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power.
RESULTS
This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = - 0.16, 95% CI = - 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = - 0.12 to 0.15; P = 0.86).
CONCLUSION
Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.
Topics: Basement Membrane; Epiretinal Membrane; Humans; Retinal Perforations; Retrospective Studies; Surgical Flaps; Treatment Outcome; Visual Acuity; Vitrectomy
PubMed: 31914954
DOI: 10.1186/s12886-019-1271-2 -
International Journal of Ophthalmology 2019To evaluate the effect of internal limiting membrane (ILM) peeling with indocyanine green (ICG), brilliant blue G (BBG), triamcinolone acetonide (TA), trypan blue (TB),...
AIM
To evaluate the effect of internal limiting membrane (ILM) peeling with indocyanine green (ICG), brilliant blue G (BBG), triamcinolone acetonide (TA), trypan blue (TB), or without dye for the treatment of idiopathic macular hole (IMH).
METHODS
A search was conducted using PubMed, EMBASE, and CENTRAL (Cochrane Central Register of Controlled Trials) for related studies published before October 2018.
RESULTS
A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye.
CONCLUSION
BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.
PubMed: 31850178
DOI: 10.18240/ijo.2019.12.15 -
The Cochrane Database of Systematic... Dec 2019A giant retinal tear (GRT) is a full-thickness neurosensory retinal break extending for 90° or more in the presence of a posterior vitreous detachment. (Meta-Analysis)
Meta-Analysis
BACKGROUND
A giant retinal tear (GRT) is a full-thickness neurosensory retinal break extending for 90° or more in the presence of a posterior vitreous detachment.
OBJECTIVES
To evaluate the effectiveness and safety of pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for eyes with giant retinal tear.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 8), which contains the Cochrane Eyes and Vision Trials Register; Ovid MEDLINE; Embase.com; PubMed; Latin American and Caribbean Literature on Health Sciences (LILACS); ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in our electronic search. We last searched the electronic databases on 16 August 2018.
SELECTION CRITERIA
We included only randomized controlled trials (RCTs) comparing pars plana vitrectomy combined with scleral buckle versus pars plana vitrectomy alone for giant retinal tear regardless of age, gender, lens status (e.g. phakic or pseudophakic eyes) of the affected eye(s), or etiology of GRT among participants enrolled in these trials.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed titles and abstracts, then full-text articles, using Covidence. Any differences in classification between the two review authors were resolved through discussion. Two review authors independently abstracted data and assessed risk of bias of included trials.
MAIN RESULTS
We found two RCTs in abstract format (105 participants randomized). Neither RCT was published in full. Based on the data presented in the abstracts, scleral buckling might be beneficial (relative risk of re-attachement ranged from 3.0 to 4.4), but the findings are inconclusive due to a lack of peer reviewed publication and insufficient information for assessing risk of bias.
AUTHORS' CONCLUSIONS
We found no conclusive evidence from RCTs on which to base clinical recommendations for scleral buckle combined with pars plana vitrectomy for giant retinal tear. RCTs are clearly needed to address this evidence gap. Such trials should be randomized, and patients should be classified by giant retinal tear characteristics (extension (90º, 90º to 180º, > 180º), location (oral, anterior, posterior to equator)), proliferative vitreoretinopathy stage, and endotamponade. Analysis should include both short-term (three months and six months) and long-term (one year to two years) outcomes for primary retinal reattachment, mean change in best corrected visual acuity, study eyes that required second surgery for retinal reattachment, and adverse events such as elevation of intraocular pressure above 21 mmHg, choroidal detachment, cystoid macular edema, macular pucker, proliferative vitreoretinopathy, and progression of cataract in initially phakic eyes.
Topics: Humans; Randomized Controlled Trials as Topic; Retinal Detachment; Retinal Perforations; Scleral Buckling; Treatment Outcome; Vitrectomy
PubMed: 31840810
DOI: 10.1002/14651858.CD012646.pub2 -
Retina (Philadelphia, Pa.) Jan 2020To evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate repeated surgery for idiopathic full-thickness macular hole that failed to close (FTC) after first surgery or reopened (RO) once originally closed.
METHODS
Systematic review and meta-analysis. Pubmed.gov and Cochrane Library were searched for studies in English presenting outcomes of idiopathic full-thickness macular hole that FTC or RO (case reports/series of <5 cases excluded).
OUTCOME MEASURES
Anatomical closure, postoperative best-corrected visual acuity, intraoperative/postoperative complications, and patient-reported outcomes. Meta-analysis was performed on aggregate and available individual participant data sets using the metafor package in R.
RESULTS
Twenty-eight eligible studies were identified. After reoperation, pooled estimates for anatomical closure were 78% (95% confidence interval 71-84%) and 80% (95% confidence interval 66-89%) for FTC and RO groups, respectively. On average, best-corrected visual acuity improved in both groups. However, only 15% (28 of 189 eyes) of FTC eyes achieved best-corrected visual acuity of ≥6/12. The pooled estimated probability of ≥2-line best-corrected visual acuity improvement was 58% in the FTC group (95% confidence interval 45-71%); meta-analysis was not possible in the RO group. The most common complication was cataract.
CONCLUSION
Reoperation for FTC or RO idiopathic full-thickness macular hole achieved a clinically meaningful visual acuity improvement in more than half of patients; high levels of vision (≥6/12), however, were uncommon.
Topics: Basement Membrane; Humans; Intraoperative Complications; Postoperative Complications; Reoperation; Retinal Perforations; Treatment Failure; Visual Acuity; Vitrectomy; Vitreoretinal Surgery
PubMed: 31335482
DOI: 10.1097/IAE.0000000000002564 -
Eye (London, England) Oct 2019To evaluate the effect of vitrectomy with inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD) in high myopia... (Meta-Analysis)
Meta-Analysis
Vitrectomy with inverted internal limiting membrane flap versus internal limiting membrane peeling for macular hole retinal detachment in high myopia: a systematic review of literature and meta-analysis.
PURPOSE
To evaluate the effect of vitrectomy with inverted internal limiting membrane (ILM) flap for the treatment of macular hole retinal detachment (MHRD) in high myopia compared with that of ILM peeling.
METHODS
PubMed, EMBASE, Web of Science, MEDLINE, Ovid, Wan Fang and CNKI were systematically reviewed. The primary outcome parameters were the MH closure rate, retinal reattachment rate and postoperative BCVA. Secondary outcome parameters, included intraoperative or postoperative complications.
RESULTS
Seven retrospective comparative studies including 228 eyes were selected. No significant difference was detected in either postoperative BCVA (MD -0.07; 95% CI: -0.17 to 0.03; p = 0.16) or the improvement in postoperative BCVA (MD -0.17; 95% CI: -0.50 to 0.16; p = 0.32) between the ILM flap group and ILM peeling group. The retinal reattachment rate using inverted ILM flap was not significantly different from that using ILM peeling (odds ratio (OR) 2.24; 95% CI: 0.75-6.73; p = 0.15). The MH closure rate was higher with inverted ILM flap than with ILM peeling (OR 11.86; 95% CI: 5.65 to 24.92; p < 0.00001). There was no significant difference in intraoperative or postoperative complications, including concomitant cataract rate (OR 1.22; 95% CI: 0.42-3.58; p = 0.71).
CONCLUSION
The inverted ILM flap technique could contribute to a higher MH closure rate than ILM peeling, but visual improvement was similar. Both surgical methods could obtain a high-retinal reattachment rate with fewer intraoperative and postoperative complications.
Topics: Basement Membrane; Female; Humans; Male; Myopia, Degenerative; Retinal Detachment; Retinal Perforations; Retrospective Studies; Surgical Flaps; Vitrectomy
PubMed: 31073163
DOI: 10.1038/s41433-019-0458-3 -
Journal of Ophthalmology 2019A systematic literature search was conducted to identify and review studies comparing SF to CF as a tamponade agent in the intraoperative management of macular holes. (Review)
Review
PURPOSE
A systematic literature search was conducted to identify and review studies comparing SF to CF as a tamponade agent in the intraoperative management of macular holes.
METHODS
Publications up to October 2018 that focused on macular hole surgery in terms of primary closure, complications, and clinical outcomes were included. Forest plots were created using a weighted summary of proportion meta-analysis. Analysis was performed separately for SF and CF. A random effects model was used, and corresponding heterogeneity estimates were calculated.
RESULTS
Nine pertinent publications studying a total of 4,715 patients were identified in 2000 to 2017, including two randomized studies (=206), two prospective studies (=170), and five retrospective or registry-based studies. Similar rates of closure between SF and CF were reported in eight out of nine studies, regardless of subgroup analyses. All studies reporting visual outcomes showed similar results when comparing SF to CF at one to six months of follow-up. Neither agent was clearly associated with increased risk of ocular hypertension, cataract formation, or other adverse events. Meta-analytic pooling of the closure rates in the SF group resulted in 91.73% (95% confidence interval: 88.40 to 94.55, : 38.03%), and for CF, the closure rate was 88.36% (95% confidence interval: 85.88 to 90.63, : 0.0%).
CONCLUSIONS
Both SF and CF appear to have achieved similar visual outcomes and primary closure rates and neither was associated with an increased risk of adverse events. Considering the more rapid visual recovery with SF, there appears to be no evidence to support CF as the tamponade agent of choice for macular hole surgery.
PubMed: 30993017
DOI: 10.1155/2019/1820850