Inverted internal limiting membrane flap technique for large macular holes: a systematic review and single-arm meta-analysis

Review Article
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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Large macular hole Inverted internal limiting membrane flap technique Internal limiting membrane peeling 

Notes

Acknowledgements

The authors would like to thank Chen Zou and Jili Chen for their suggestions and assistance in the present study.

Funding

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.

Ethical approval

For this type of study, formal consent is not required.

Informed consent

For this type of study formal consent is not required.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Ophthalmology, Shanghai General HospitalShanghai Jiao Tong University School of MedicineShanghaiPeople’s Republic of China
  2. 2.Shanghai Key Laboratory of Ocular Fundus DiseasesShanghaiPeople’s Republic of China
  3. 3.Shanghai Engineering Center for Visual Science and PhotomedicineShanghaiPeople’s Republic of China
  4. 4.Department of OphthalmologyShigatse People’s HospitalXizangPeople’s Republic of China

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