Inverted internal limiting membrane flap technique for large macular holes: a systematic review and single-arm meta-analysis
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The aim of this systematic review was to determine the anatomical outcome—macular hole (MH) closure rate—and functional outcome—visual acuity (VA) improvement rate—of the inverted internal limiting membrane (ILM) flap technique for large MH.
We searched for articles on large MH (> 400 μm) treated with inverted ILM flap technique in databases as of December 1, 2017. And single-arm meta-analysis was performed for the primary outcome of MH closure rate and the secondary outcome of VA improvement rate. In addition, we searched and pooled studies treating large MH with indocyanine green (ICG)-assisted ILM peeling as the reference. R software (version 2.15.2) was used for analysis.
This review includes eight studies that used inverted ILM flap technique to treat large MH (> 400 μm). Based on the single-arm meta-analysis performed in R 2.15.2, the pooled MH closure rate and VA improvement rate following inverted ILM flap technique were 95% (95% CI, 88 to 98%) and 75% (95% CI, 62 to 85%), respectively, in fixed-effect models. There was no substantial methodological heterogeneity. In addition, we selected four studies on large MH treated with ICG-assisted ILM peeling as the reference. The fixed-model pooled MH closure rate and VA improvement rate were 87% (95% CI, 79 to 92%) and 57% (95% CI, 46 to 68%), respectively.
Inverted ILM flap technique should be an effective and safe method for treating large MH, with high closure rates and good VA improvement. However, further studies in large randomized controlled trials on minimizing surgical complications and understanding the mechanism of this technique are necessary.
KeywordsLarge macular hole Inverted internal limiting membrane flap technique Internal limiting membrane peeling
The authors would like to thank Chen Zou and Jili Chen for their suggestions and assistance in the present study.
This work was supported by the Tibet Natural Science Foundation of China (Grant No. XZ2017ZR-ZYZ09). The funding body had no role in the design or conduct of this research.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
For this type of study, formal consent is not required.
For this type of study formal consent is not required.
- 6.Michalewska Z, Michalewski J, Nawrocki J (2009) Macular hole closure after vitrectomy—the inverted flap technique. RETINA TODAY:73–74Google Scholar
- 9.Chen Z, Zhao C, Ye JJ, Wang XQ, Sui RF (2016) Inverted internal limiting membrane flap technique for repair of large macular holes: a short-term follow-up of anatomical and functional outcomes. Chin Med J 129(5):511–517. https://doi.org/10.4103/0366-6999.176988 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Kase S, Saito W, Mori S, Saito M, Ando R, Dong Z, Suzuki T, Noda K, Ishida S (2017) Clinical and histological evaluation of large macular hole surgery using the inverted internal limiting membrane flap technique. Clin Ophthalmol 11:9–14. https://doi.org/10.2147/opth.s119762 CrossRefPubMedGoogle Scholar
- 15.Aromataris E, Munn Z (editors) (2017) Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute. https://reviewersmanual.joannabriggs.org/. Accessed 2 December 2017
- 17.Ul Hasan S, Rizvi SF, Mahmood SA, Zafar S, Hasan T (2017) Anatomical outcome following indocyanine green assisted internal limiting membrane peeling for stage 3 and 4 macular hole surgery. J Coll Physicians Surg Pak 27(8):486–489Google Scholar
- 22.Shiode Y, Morizane Y, Matoba R, Hirano M, Doi S, Toshima S, Takahashi K, Araki R, Kanzaki Y, Hosogi M, Yonezawa T, Yoshida A, Shiraga F (2017) The role of inverted internal limiting membrane flap in macular hole closure. Investig Ophthalmol Vis Sci 58(11):4847–4855. https://doi.org/10.1167/iovs.17-21756 CrossRefGoogle Scholar
- 23.Deshpande R, Narayanan R (2015) Surgical repair of a giant idiopathic macular hole by inverted internal limiting membrane flap. BMJ Case Rep. https://doi.org/10.1136/bcr-2015-210797
- 24.Hirano M, Morizane Y, Kawata T, Kimura S, Hosokawa M, Shiode Y, Doi S, Hosogi M, Fujiwara A, Shiraga F (2015) Case report: successful closure of a large macular hole secondary to uveitis using the inverted internal limiting membrane flap technique. BMC Ophthalmol 15:83. https://doi.org/10.1186/s12886-015-0072-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Casini G, Mura M, Figus M, Loiudice P, Peiretti E, Cilla SD, Fuentes T, Nasini F (2017) Inverted internal limiting membrane flap technique for macular hole surgery without extra manipulation of the flap. Retina 0:1–7Google Scholar