Macular Buckle, Vitrectomy, or Combined Approach for the Management of Macular Hole Retinal Detachment: A Systematic Review and Network Meta-Analysis.

Topic: There is no consensus regarding management of macular hole retinal detachment (MHRD). Techniques such as trans pars plana vitrectomy (TPPV), macular buckle (MB), and combined approach have been described.

Clinical relevance: To review anatomical and functional outcomes of different surgical interventions for MHRD.

Methods: A systematic literature review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (International Prospective Register of Systematic Reviews registration number CRD42024586953). Literature search was performed in PubMed, Embase, Cochrane Library, and clinical trial databases for randomized controlled trials or retrospective comparative studies reporting MHRD outcomes until February 15, 2025. Retinal reattachment rates, macular hole closure rates, functional outcomes, and complications were assessed. Frequentist Meta-Analysis of Proportions and Bayesian Network Meta-Analysis were conducted. Study quality was assessed with Cochrane's Risk of Bias in Nonrandomized Studies of Interventions 2.0 tool and Risk of Bias Tool 2.

Results: Five studies and 308 eyes were analyzed. Retinal reattachment rates were significantly higher in combined (96.9%) and MB (96.2%) versus vitrectomy (66.9%). There was no significant difference between combined and MB (P = 0.802; risk ratio [RR] = 1.03, 95% confidence interval [CI]: 0.94-1.12; τ² = 0.00, I² = 0.00; Grading of Recommendations, Assessment, Development, and Evaluation [GRADE], moderate certainty, 4 studies, 173 eyes), whereas TPPV did significantly worse relative to MB (P < 0.001; RR = 0.64, 95% CI: 0.50-0.79; τ² = 0.00, I² = 0.00; GRADE, moderate certainty, 4 studies, 233 eyes). Macular hole closure rates were highest in the combined group (86.0%; MB, 58.4%; and TPPV, 46.3%); (Combined vs. MB: P = 0.148; RR = 1.24, 95% CI: 0.88-1.61; τ² = 0.00, I² = 0.00%; GRADE, moderate certainty of evidence, 4 studies, 173 eyes); (Vitrectomy vs. MB: P = 0.158; RR = 0.73, 95% CI: 0.40-1.05; τ² = 0.00, I² = 0.00%; GRADE, low certainty of evidence, 4 studies, 233 eyes). The postoperative visual acuity improvements for MB, combined, and TPPV were a logarithm of the minimum angle of resolution of 0.533, 0.510, and 0.434, respectively.

Conclusion: Our study found that procedures involving MB was associated with better retinal reattachment rates in managing MHRD with moderate certainty. Further studies are required to evaluate macular hole closure rates, visual outcomes, and retinal reattachment rates after a combined procedure.

Financial disclosure(s): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.