Syed Muhammad Muneeb Akhtar, Syed Zia Saleem, Syed Ali Asad Rizvi, Areeba Fareed, Munazza Mumtaz, Shiza Saleem, Anusha Bai, Afsana Ansari Shaik, Robert Kirchoff, Muhammad Sohaib Asghar
{"title":"黄斑裂孔修复技术的关键分析：一项比较任何大小黄斑裂孔的内限制膜瓣和内限制膜剥离的综合系统综述和荟萃分析。","authors":"Syed Muhammad Muneeb Akhtar, Syed Zia Saleem, Syed Ali Asad Rizvi, Areeba Fareed, Munazza Mumtaz, Shiza Saleem, Anusha Bai, Afsana Ansari Shaik, Robert Kirchoff, Muhammad Sohaib Asghar","doi":"10.1186/s12886-025-04011-0","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Macular holes (MHs) are a leading cause of visual impairment and blindness worldwide defined as a partial or full thickness anatomical defect in the fovea of the retina. ILM peeling is an effective surgical procedure to repair the defect. However, this approach lacks efficacy for larger macular holes. ILM flap is a novel technique with demonstrated efficacy for repair of larger defects.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aims to compare the effectiveness of these two techniques in treating any size and type of MH.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were MH closure rate and postoperative VA. The statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Pooled odds ratios (ORs), mean differences (MD), and 95% confidence intervals (CIs) were calculated. All statistical analyses were performed using R Statistical Software and meta package v4.17-0.</p><p><strong>Results: </strong>A total of thirty-two studies, comprising nine RCTs and twenty three retrospective studies were included in this meta-analysis, which involved 1220 eyes in the ILM flap group and 1277 eyes in the ILM peeling group. The overall MH closure rate significantly favored ILM flap technique (OR = 2.47, CI = 1.58 to 3.87; P < 0.001; I²= 30%). The overall pooled result for postoperative VA, no significant difference was observed between the two surgical methods. However, it favored ILM flap technique on subgroup analysis based on study type and MH size specifically in the RCTS with macular hole size > 400 μm (MD = -0.13, 95% CI = -0.17 to -0.08, p < 0.01; I<sup>2</sup> = 13%), as well as on subgrouping based on follow-up duration (MD = -0.11, 95% CI = -0.14 to -0.08, p < 0.01; I<sup>2</sup> = 25%).</p><p><strong>Conclusion: </strong>ILM flap technique resulted in significantly better closure rate with all sizes of MHs, coupled with improved visual acuity in larger MHs and with follow-up duration.</p>","PeriodicalId":9058,"journal":{"name":"BMC Ophthalmology","volume":"25 1","pages":"174"},"PeriodicalIF":1.7000,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole.\",\"authors\":\"Syed Muhammad Muneeb Akhtar, Syed Zia Saleem, Syed Ali Asad Rizvi, Areeba Fareed, Munazza Mumtaz, Shiza Saleem, Anusha Bai, Afsana Ansari Shaik, Robert Kirchoff, Muhammad Sohaib Asghar\",\"doi\":\"10.1186/s12886-025-04011-0\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Macular holes (MHs) are a leading cause of visual impairment and blindness worldwide defined as a partial or full thickness anatomical defect in the fovea of the retina. ILM peeling is an effective surgical procedure to repair the defect. However, this approach lacks efficacy for larger macular holes. ILM flap is a novel technique with demonstrated efficacy for repair of larger defects.</p><p><strong>Objective: </strong>This systematic review and meta-analysis aims to compare the effectiveness of these two techniques in treating any size and type of MH.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were MH closure rate and postoperative VA. The statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Pooled odds ratios (ORs), mean differences (MD), and 95% confidence intervals (CIs) were calculated. All statistical analyses were performed using R Statistical Software and meta package v4.17-0.</p><p><strong>Results: </strong>A total of thirty-two studies, comprising nine RCTs and twenty three retrospective studies were included in this meta-analysis, which involved 1220 eyes in the ILM flap group and 1277 eyes in the ILM peeling group. The overall MH closure rate significantly favored ILM flap technique (OR = 2.47, CI = 1.58 to 3.87; P < 0.001; I²= 30%). The overall pooled result for postoperative VA, no significant difference was observed between the two surgical methods. However, it favored ILM flap technique on subgroup analysis based on study type and MH size specifically in the RCTS with macular hole size > 400 μm (MD = -0.13, 95% CI = -0.17 to -0.08, p < 0.01; I<sup>2</sup> = 13%), as well as on subgrouping based on follow-up duration (MD = -0.11, 95% CI = -0.14 to -0.08, p < 0.01; I<sup>2</sup> = 25%).</p><p><strong>Conclusion: </strong>ILM flap technique resulted in significantly better closure rate with all sizes of MHs, coupled with improved visual acuity in larger MHs and with follow-up duration.</p>\",\"PeriodicalId\":9058,\"journal\":{\"name\":\"BMC Ophthalmology\",\"volume\":\"25 1\",\"pages\":\"174\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-04-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"BMC Ophthalmology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12886-025-04011-0\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OPHTHALMOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12886-025-04011-0","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：黄斑裂孔（MHs）是世界范围内导致视力损害和失明的主要原因之一，它被定义为视网膜中央窝部分或全层的解剖缺陷。ILM剥离是一种有效的修复缺陷的手术方法。然而，这种方法对较大的黄斑孔缺乏疗效。ILM皮瓣是一种新型的修复较大缺损的技术。目的：本系统综述和荟萃分析旨在比较这两种技术在治疗任何规模和类型的mhc中的有效性。方法：在PubMed、Medline和Cochrane图书馆数据库中进行全面的文献检索，以确定相关文章。主要结局指标为MH闭合率和术后VA。通过异质性、发表偏倚、敏感性分析和亚组分析来保证统计有效性。计算合并优势比（ORs）、平均差异（MD）和95%置信区间（ci）。所有统计分析均使用R统计软件和元软件包v4.17-0进行。结果：本荟萃分析共纳入32项研究，包括9项随机对照试验和23项回顾性研究，其中ILM皮瓣组1220只眼，ILM剥离组1277只眼。整体MH闭合率显著优于ILM皮瓣技术(OR = 2.47, CI = 1.58 ~ 3.87；P 400 μm (MD = -0.13, 95% CI = -0.17至-0.08,P 2 = 13%)，以及基于随访时间的亚组（MD = -0.11, 95% CI = -0.14至-0.08,P 2 = 25%）。结论：ILM皮瓣技术可显著提高所有大小间质瘤的闭合率，并可改善较大间质瘤的视力和随访时间。
Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole.
Background: Macular holes (MHs) are a leading cause of visual impairment and blindness worldwide defined as a partial or full thickness anatomical defect in the fovea of the retina. ILM peeling is an effective surgical procedure to repair the defect. However, this approach lacks efficacy for larger macular holes. ILM flap is a novel technique with demonstrated efficacy for repair of larger defects.
Objective: This systematic review and meta-analysis aims to compare the effectiveness of these two techniques in treating any size and type of MH.
Methods: A comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were MH closure rate and postoperative VA. The statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Pooled odds ratios (ORs), mean differences (MD), and 95% confidence intervals (CIs) were calculated. All statistical analyses were performed using R Statistical Software and meta package v4.17-0.
Results: A total of thirty-two studies, comprising nine RCTs and twenty three retrospective studies were included in this meta-analysis, which involved 1220 eyes in the ILM flap group and 1277 eyes in the ILM peeling group. The overall MH closure rate significantly favored ILM flap technique (OR = 2.47, CI = 1.58 to 3.87; P < 0.001; I²= 30%). The overall pooled result for postoperative VA, no significant difference was observed between the two surgical methods. However, it favored ILM flap technique on subgroup analysis based on study type and MH size specifically in the RCTS with macular hole size > 400 μm (MD = -0.13, 95% CI = -0.17 to -0.08, p < 0.01; I2 = 13%), as well as on subgrouping based on follow-up duration (MD = -0.11, 95% CI = -0.14 to -0.08, p < 0.01; I2 = 25%).
Conclusion: ILM flap technique resulted in significantly better closure rate with all sizes of MHs, coupled with improved visual acuity in larger MHs and with follow-up duration.
期刊介绍：
BMC Ophthalmology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of eye disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
