Boon Lin Teh, Yanda Li, Keean Nanji, Mark Phillips, Varun Chaudhary, David H Steel
{"title":"内限制膜剥离大小与黄斑孔手术结果：随机对照试验的系统回顾和个体参与者数据研究。","authors":"Boon Lin Teh, Yanda Li, Keean Nanji, Mark Phillips, Varun Chaudhary, David H Steel","doi":"10.1038/s41433-025-03666-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is no consensus regarding the optimal internal limiting membrane (ILM) peel size during vitrectomy for idiopathic full thickness macular holes (iFTMH).</p><p><strong>Methods: </strong>A systematic review was performed to identify randomized controlled trials (RCTs) comparing vitrectomy with ILM peeling of differing sizes in adults with iFTMH. Individual participant data was obtained including relevant baseline variables. The effect of different ILM peel sizes, divided into \"small\" (1-disc diameter [DD] in radius or less) and \"large\" (>1-DD in radius) were analysed on primary hole closure and postoperative visual acuity (VA) at 6 months. A subgroup analysis analysing for the effect of macular hole size on the same outcomes was also performed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess the certainty of evidence.</p><p><strong>Results: </strong>Five RCTs with 370 eyes were included. Primary closure was achieved in 74.7% in small peel group compared to 84.8% in large peel group (p = 0.016). Multilevel logistic regression showed that a peel radius of >1-DD probably improved hole closure slightly with odds ratio (OR) of 1.20 (95% CI: 1.11-1.31, p < 0.001) and a number needed to treat (NNT) to benefit of 31 (95% CI: 21-53). ILM peel size likely did not affect VA. The mean difference in postoperative VA was a -0.05 logMAR gain (2-3 ETDRS letters) (95% CI: -0.13 to 0.02, p = 0.155) in vision with a large ILM peel radius. The GRADE certainty of evidence was moderate for both outcomes. A significantly higher closure rate was found in the large peel group for iFTMH >400 microns with an OR of 1.24 (95% CI: 1.11-1.38, p < 0.001) and NNT to benefit of 21 (95% CI: 17-50), but not in holes <400 microns (OR 1.05 (95% CI: 0.93-1.18, p = 0.396)).</p><p><strong>Conclusions: </strong>Performing ILM peel of more than 1-DD in radius likely improves closure rates for iFTMH although the effect size is relatively small. The effect is greater in holes >400 microns. ILM peel size probably has no significant effect on postoperative VA.</p>","PeriodicalId":12125,"journal":{"name":"Eye","volume":" ","pages":"1406-1413"},"PeriodicalIF":2.8000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044072/pdf/","citationCount":"0","resultStr":"{\"title\":\"Internal limiting membrane peel size and macular hole surgery outcome: a systematic review and individual participant data study of randomized controlled trials.\",\"authors\":\"Boon Lin Teh, Yanda Li, Keean Nanji, Mark Phillips, Varun Chaudhary, David H Steel\",\"doi\":\"10.1038/s41433-025-03666-9\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is no consensus regarding the optimal internal limiting membrane (ILM) peel size during vitrectomy for idiopathic full thickness macular holes (iFTMH).</p><p><strong>Methods: </strong>A systematic review was performed to identify randomized controlled trials (RCTs) comparing vitrectomy with ILM peeling of differing sizes in adults with iFTMH. Individual participant data was obtained including relevant baseline variables. The effect of different ILM peel sizes, divided into \\\"small\\\" (1-disc diameter [DD] in radius or less) and \\\"large\\\" (>1-DD in radius) were analysed on primary hole closure and postoperative visual acuity (VA) at 6 months. A subgroup analysis analysing for the effect of macular hole size on the same outcomes was also performed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess the certainty of evidence.</p><p><strong>Results: </strong>Five RCTs with 370 eyes were included. Primary closure was achieved in 74.7% in small peel group compared to 84.8% in large peel group (p = 0.016). Multilevel logistic regression showed that a peel radius of >1-DD probably improved hole closure slightly with odds ratio (OR) of 1.20 (95% CI: 1.11-1.31, p < 0.001) and a number needed to treat (NNT) to benefit of 31 (95% CI: 21-53). ILM peel size likely did not affect VA. The mean difference in postoperative VA was a -0.05 logMAR gain (2-3 ETDRS letters) (95% CI: -0.13 to 0.02, p = 0.155) in vision with a large ILM peel radius. The GRADE certainty of evidence was moderate for both outcomes. A significantly higher closure rate was found in the large peel group for iFTMH >400 microns with an OR of 1.24 (95% CI: 1.11-1.38, p < 0.001) and NNT to benefit of 21 (95% CI: 17-50), but not in holes <400 microns (OR 1.05 (95% CI: 0.93-1.18, p = 0.396)).</p><p><strong>Conclusions: </strong>Performing ILM peel of more than 1-DD in radius likely improves closure rates for iFTMH although the effect size is relatively small. The effect is greater in holes >400 microns. 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Internal limiting membrane peel size and macular hole surgery outcome: a systematic review and individual participant data study of randomized controlled trials.
Background: There is no consensus regarding the optimal internal limiting membrane (ILM) peel size during vitrectomy for idiopathic full thickness macular holes (iFTMH).
Methods: A systematic review was performed to identify randomized controlled trials (RCTs) comparing vitrectomy with ILM peeling of differing sizes in adults with iFTMH. Individual participant data was obtained including relevant baseline variables. The effect of different ILM peel sizes, divided into "small" (1-disc diameter [DD] in radius or less) and "large" (>1-DD in radius) were analysed on primary hole closure and postoperative visual acuity (VA) at 6 months. A subgroup analysis analysing for the effect of macular hole size on the same outcomes was also performed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess the certainty of evidence.
Results: Five RCTs with 370 eyes were included. Primary closure was achieved in 74.7% in small peel group compared to 84.8% in large peel group (p = 0.016). Multilevel logistic regression showed that a peel radius of >1-DD probably improved hole closure slightly with odds ratio (OR) of 1.20 (95% CI: 1.11-1.31, p < 0.001) and a number needed to treat (NNT) to benefit of 31 (95% CI: 21-53). ILM peel size likely did not affect VA. The mean difference in postoperative VA was a -0.05 logMAR gain (2-3 ETDRS letters) (95% CI: -0.13 to 0.02, p = 0.155) in vision with a large ILM peel radius. The GRADE certainty of evidence was moderate for both outcomes. A significantly higher closure rate was found in the large peel group for iFTMH >400 microns with an OR of 1.24 (95% CI: 1.11-1.38, p < 0.001) and NNT to benefit of 21 (95% CI: 17-50), but not in holes <400 microns (OR 1.05 (95% CI: 0.93-1.18, p = 0.396)).
Conclusions: Performing ILM peel of more than 1-DD in radius likely improves closure rates for iFTMH although the effect size is relatively small. The effect is greater in holes >400 microns. ILM peel size probably has no significant effect on postoperative VA.
期刊介绍：
Eye seeks to provide the international practising ophthalmologist with high quality articles, of academic rigour, on the latest global clinical and laboratory based research. Its core aim is to advance the science and practice of ophthalmology with the latest clinical- and scientific-based research. Whilst principally aimed at the practising clinician, the journal contains material of interest to a wider readership including optometrists, orthoptists, other health care professionals and research workers in all aspects of the field of visual science worldwide. Eye is the official journal of The Royal College of Ophthalmologists.
Eye encourages the submission of original articles covering all aspects of ophthalmology including: external eye disease; oculo-plastic surgery; orbital and lacrimal disease; ocular surface and corneal disorders; paediatric ophthalmology and strabismus; glaucoma; medical and surgical retina; neuro-ophthalmology; cataract and refractive surgery; ocular oncology; ophthalmic pathology; ophthalmic genetics.
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