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Efficacy of different doses of dye-assisted internal limiting membrane peeling in idiopathic macular hole: a systematic review and network meta-analysis

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Abstract

Purpose

Pars plana vitrectomy is the gold standard for the treatment of idiopathic macular hole. Several chromovitrectomy dyes have been used to improve the visualization of the internal limiting membrane (ILM), including indocyanine green, trypan blue (TB), brilliant blue G (BBG), and triamcinolone acetonide (TA). We conducted a network meta-analysis (NMA) to establish the optimum concentration of chromovitrectomy dye-assisted ILM peeling for IMH.

Methods

We searched PubMed, Embase, and Cochrane Library for relevant studies before January 2020. We performed a random-effects NMA using STATA version 15.1 to assess mean difference and odds ratios with 95% confidence intervals.

Results

We identified twelve retrospective trails and five randomized controlled trials (RCTs), comprising 1 492 patients of IMH on stage II–IV for ILM peeling. The results of IMH closure rate show that the effect of ILM peeling without dye was better than 0.25% ICG, the effects of ILM peeling with 0.5% ICG or TA were better than without dye, and the effects of ILM peeling with 0.05% BBG, 0.15% TB, 0.5% ICG or 0.05% ICG were better than 0.25% ICG. Ranking probability analysis shows that the rates of IMH closure after ILM peeling with 0.15% TB or 0.05% BBG were better than nine other concentrations of chromovitrectomy dyes.

Conclusion

The 0.15% TB and 0.05% BBG were recommended as the better efficient treatment-assisted ILM peeling for IMH closure. For retina specialists who prefer to use ICG to assist ILM peeling, 0.05% ICG may be a good choice. However, high-quality large-scale RCTs are recommended to confirm the NMA results.

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Funding

This study was funded by the National Natural Science Foundation of China (grant number 81870686); the Capital's Funds for Health Improvement and Research (grant number 2018–1-2021); the Natural Science Foundation of Beijing Municipal (grant number 7184201); and Seed Project from Beijing Friendship Hospital and Capital Medical University (grant number YYZZ2017B06).

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Authors and Affiliations

  1. Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Shan-Shan Li, Ran You, Lu Zhao, Yan-Ling Wang & Xi Chen

  2. Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Disease, Beijing, China

    Min Li

  3. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China

    Hui-Hui Wang

Authors
  1. Shan-Shan Li
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  2. Min Li
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  3. Ran You
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  4. Hui-Hui Wang
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  5. Lu Zhao
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  6. Yan-Ling Wang
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  7. Xi Chen
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Contributions

Shanshan Li, Ran You, Huihui Wang, and Lu Zhao contributed to data collection, Shanshan Li, Min Li, Yanling Wang, and Xi Chen contributed to data analysis, Yanling Wang and Xi Chen contributed to project planning, Shanshan Li and Xi Chen contributed to manuscript writing.

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Correspondence to Yan-Ling Wang or Xi Chen.

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Li, SS., Li, M., You, R. et al. Efficacy of different doses of dye-assisted internal limiting membrane peeling in idiopathic macular hole: a systematic review and network meta-analysis. Int Ophthalmol 41, 1129–1140 (2021). https://doi.org/10.1007/s10792-020-01656-2

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