SynthesisEye (London, England)2025
Internal limiting membrane peel size and macular hole surgery outcome: a systematic review and individual participant data study of randomized controlled trials.
Synthesis in Eye (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Retinal sensitivity assessed by microperimetry and its topographic correlation with macular structure by optical coherence tomography following macular hole surgery: a cross-sectional study.International journal of retina and vitreous · 2026Article
- Simple Superior Inverted Flap Technique with Extended Internal Limiting Membrane Peeling for the Treatment of Large Macular Holes.Clinical ophthalmology (Auckland, N.Z.) · 2026Article
- Prediction of visual recovery after idiopathic macular hole surgery: a triad of tractional mechanics, subfoveal anatomy, and preoperative function.International journal of ophthalmology · 2026Article
- Controversies, consensuses, and guidelines on macular hole surgery by the Asia-Pacific Vitreo-retina Society (APVRS) and the Asia-Pacific Academy of Professors in Ophthalmology (AAPPO).Eye and vision (London, England) · 2025Review
- Vitrectomy with inner limiting membrane peeling effectively reduces ellipsoid zone defect diameter in patients with idiopathic macular holes.American journal of translational research · 2025Article
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is no consensus regarding the optimal internal limiting membrane (ILM) peel size during vitrectomy for idiopathic full thickness macular holes (iFTMH).
methodsA systematic review was performed to identify randomized controlled trials (RCTs) comparing vitrectomy with ILM peeling of differing sizes in adults with iFTMH. Individual participant data was obtained including relevant baseline variables. The effect of different ILM peel sizes, divided into "small" (1-disc diameter [DD] in radius or less) and "large" (>1-DD in radius) were analysed on primary hole closure and postoperative visual acuity (VA) at 6 months. A subgroup analysis analysing for the effect of macular hole size on the same outcomes was also performed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess the certainty of evidence.
resultsFive RCTs with 370 eyes were included. Primary closure was achieved in 74.7% in small peel group compared to 84.8% in large peel group (p = 0.016). Multilevel logistic regression showed that a peel radius of >1-DD probably improved hole closure slightly with odds ratio (OR) of 1.20 (95% CI: 1.11-1.31, p < 0.001) and a number needed to treat (NNT) to benefit of 31 (95% CI: 21-53). ILM peel size likely did not affect VA. The mean difference in postoperative VA was a -0.05 logMAR gain (2-3 ETDRS letters) (95% CI: -0.13 to 0.02, p = 0.155) in vision with a large ILM peel radius. The GRADE certainty of evidence was moderate for both outcomes. A significantly higher closure rate was found in the large peel group for iFTMH >400 microns with an OR of 1.24 (95% CI: 1.11-1.38, p < 0.001) and NNT to benefit of 21 (95% CI: 17-50), but not in holes <400 microns (OR 1.05 (95% CI: 0.93-1.18, p = 0.396)).
conclusionsPerforming ILM peel of more than 1-DD in radius likely improves closure rates for iFTMH although the effect size is relatively small. The effect is greater in holes >400 microns. ILM peel size probably has no significant effect on postoperative VA.
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