Pars Plana Vitrectomy for refractive Diabetic Macular Oedema with or without Internal Limiting Membrane Peeling: A systemic Review and Meta-Analysis

Abstract

Objective: To determine whether pars plana vitrectomy (PPV) combined with the internal limiting membrane (ILM) peeling technique improves the anatomic and functional outcomes of refractory diabetic macular oedema (DME) in comparison with PPV alone. Methods: All relevant articles published in English were retrieved from PubMed, google scholar, web of Science, scopes, and Cochrane library databases between January 1st 1990 and September 28 2022. The meta-analysis was conducted using the Statistical software R 4.2.2. Results: Among 709 articles that were initially identified, 10 studies involving 1126 eyes with DME were found to be eligible for this meta-analysis and systematic review. Our results revealed that postoperative best corrected visual acuity (BCVA) was better in the non-peeling group than in the ILM peeling group (MD=-0.08, 95% CI: -0.12, -0.04, p<0.001), the improvement of BCVA was not significant between the two groups (RD=5.59, 95% CI: -4.81, 15.99, p=0.13). The random effects model showed that changes in central macular thickness were not significantly different between the ILM peeling group and the non-ILM peel group (MD=23.10, 95% CI: -53.82, 100.02, p=0.56). Conclusion: The functional and morphological clinical outcomes in the non-inferior group are equal to that of the ILM peeling group. Yet, further large-scale prospective, randomized, controlled trials are warranted to further validate the reported results.