Pars plana vitrectomy with or without internal limiting membrane peel for macular hole: a systematic review and meta-analysis

Abstract

Purpose: To compare the efficacy and safety of pars plana vitrectomy (PPV) with and without internal limiting membrane (ILM) peeling for macular hole (MH). Methods: We performed a systematic literature search on Ovid MEDLINE, Embase, Cochrane Library and Google Scholar from January 2000-2023. Our primary outcome was the final best-corrected visual acuity (BCVA). Secondary outcomes included MH closure rates and the need for repeat surgery. We performed a random effects meta-analysis on Review Manager 5.4. Results: 14 studies on 880 eyes were included. PPV with and without ILM peel achieved a similar final BCVA (p=0.66). However, PPV without ILM peeling achieved a significantly better final BCVA in eyes with closed MHs (WMD=0.05 logMAR, 95%CI=[0.01, 0.10], p=0.02). PPV with ILM peeling achieved a significantly higher primary MH closure rate (RR=1.21, 95%CI=[1.04, 1.42], p=0.02) and lower incidence of MH reoperation (RR=0.19, 95%CI=[0.11, 0.33], p<0.001). The final MH closure rate (p=0.12) and incidence of MH recurrence (p=0.25) were similar between groups. Conclusion: PPV with and without ILM peel achieved a similar final BCVA. However, PPV without ILM peeling achieved a better final BCVA in eyes with closed MHs. ILM peeling achieved a greater primary MH closure rate and reduced need for reoperation.