Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial

Kannan, Naresh Babu; Kohli, Piyush; Parida, Haemoglobin; Adenuga, Olukorede O; Ramasamy, Kim

doi:10.1186/s12886-018-0826-y

Cited by 80 publications

(80 citation statements)

References 37 publications

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“…In histopathologic findings, when the margins of the ILM were left attached to the edges of the hole, it served as a gap-free natural scaffold for gliosis, and provided a basement membrane for proliferateglial glial cells to maintain anatomic structure of the foveola [9,10]. Shiode et al showed that the neurotrophic factors and basic fibroblast growth factors (bFGF) on the surface of the ILM flap promoted the proliferation and migration of the Müller cells, contributing to fill the MH and enhance closure [11]. Activated Müller cells also produced neurotrophic factors and growth factors that may promote the survival of retinal neurons [18].…”

Section: Discussionmentioning

confidence: 99%

“…The titles and abstracts reviewed, and the remaining 16 studies were retrieved for the next review. Finally, after reading carefully of full-texts, We included a total of 8 studies [4,[9][10][11][12][13][14][15], 4 RCTs [4, [9][10][11] and 4 case series [12][13][14][15]. Fig.…”

Section: Selection Of Studiesmentioning

confidence: 99%

“…The mean duration of symptoms varied from 3.06 to 20 months, and the average minimum diameter of MH ranged from 493.8 to 803.33 μm. The shortest follow-up duration was 3 months in 3 studies [4,10,12], the follow-up duration ≥6 months in 5 studies [9,11,[13][14][15].…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Moreover, there was still high heterogeneity between these trials in the subgroup of follow-up duration ≥6 months (heterogeneity I 2 = 68%). After reading the included four studies [11,[13][14][15] carefully, a random effects model was used in the later subgroup.…”

Section: Postoperative Visual Acuity Analysismentioning

confidence: 99%

“…Michalewska et al [9] first presented a novel technique of inverted ILM flap for the treatment of large MH, contributing to a relatively high MH closure rates. Recently, a number of clinical studies have suggested that inverted ILM flap technique achieved better anatomical and visual outcomes than ILM peeling [10][11][12][13][14][15]. However because of lacking appropriate controls, uncontrollable elements, or insufficient samples in most of these studies, the reliable evidences to support such a view were limited.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2020

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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.

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