Surgical outcomes of lamellar macular hole eyes with or without preservation of lamellar hole-associated epiretinal proliferation technique: a meta-analysis.

Purpose: To evaluate sparing or embedding technique for lamellar hole-associated epiretinal proliferation (LHEP) and in comparison with traditional internal limiting membrane (ILM) and epiretinal membrane (ERM) peeling in lamellar macular holes (LMH).

Methods: PubMed, Web of Science, Medline, EMBASE, Cochrane, CNKI, Wan Fang, and VIP Databases (PROSPERO number CRD42024466392) were searched. Trials of various LHEP removal or preservation techniques in LMH were included (case reports of only 1 case excluded). Postoperative changes in best corrected visual acuity (BCVA) and central retinal thickness (CRT) were calculated. Number of patients with new postoperative intact ellipsoid zones (EZ) was a secondary outcome.

Results: Eight studies were eligible and four compared with peeling groups. Preservation groups showed a significant visual improvement operatively (mean difference (MD) =-0.25 logMAR; 95% confidence interval (CI) =-0.30,-0.21; P<0.00001), and improved compared with peeling groups (MD=-0.19 logMAR; 95%CI=-0.29,-0.1; P<0.0001). Additionally, the number of patients with intact ellipsoid zones increased in the preserving groups (odd ratio (OR) =2.55; 95%CI=1.48, 4.38; P=0.0007), also increased compared with peeling groups (OR =10.80; 95%CI =1.86, 62.83; P=0.008).

Conclusion: Based on current evidence, LHEP sparing or embedding technique has favorable postoperative outcomes compared to peeling technique for LMH.