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Purpose: To compare the outcomes of papillomacular bundle (PMB) sparing internal limiting membrane (ILM) peeling (group LP) and conventional ILM peeling (group CP) for treatment of idiopathic macular hole (MH) of ?400 ?m. Methods: Fifteen eyes were included in each group. In group CP, conventional 360° peeling was done, while in group LP, ILM was spared over PMB. The changes in peripapillary retinal nerve fiber layer (pRNFL) thickness and ganglion cell?inner plexiform layer (GC?IPL) thickness were analyzed at 3 months. Results: MH was closed in all with comparable visual improvement. Postoperatively, retinal nerve fiber layer (RNFL) was significantly thinner in the temporal quadrant in group CP. GC?IPL was significantly thinner in the temporal quadrants in group LP, whereas it was comparable in group CP. Conclusion: PMB sparing ILM peeling is comparable to conventional ILM peeling in terms of closure rate and visual gain, with the advantage of less retinal damage at 3 months.
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Purpose: To compare the anatomical, morphological, and functional outcomes of the conventional internal limiting membrane (ILM) peeling versus temporal inverted ILM flap technique for large full?thickness macular holes (FTMHs). Methods: Sixty eyes of 60 patients with a minimum base diameter >600 ?m were included in this retrospective interventional study. Patients were divided into conventional ILM peeling (Group 1) and temporal inverted ILM flap (Group 2) groups. The hole closure rate, best?corrected visual acuity (BCVA), ellipsoid zone (EZ), and external limiting membrane (ELM) defects were analyzed at baseline and 6 months after surgery. Results: Hole closure was achieved in 24/32 (75.0%) cases of Group 1 and 27/28 (96.4%) cases of Group 2 (P = 0.029). The mean BCVA (logMAR) changed from 1.23 ± 0.47 to 0.70 ± 0.29 logMAR in Group 1 and from 1.03 ± 0.36 to 0.49 ± 0.24 logMAR in Group 2 at 6 months (P < 0.001 in both cases). U?shaped closure was observed in 5 (15.6%) eyes in Group 1 and 19 (67.9%) eyes in Group 2 (P < 0.001). The total restoration rates of ELM and EZ were significantly higher in the temporal inverted ILM flap group (P = 0.002, P = 0.001, respectively). Conclusion: The study results suggested that the FTMH closure rate, recovery of the outer retinal layers, and, consequently, the post?operative BCVA were better with the temporal inverted ILM flap technique than with the conventional ILM peeling for larger than 600 ?m macular holes.
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Objective:To observe the clinical effects of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) peeling and C 3F 8 tamponade for patients with highly myopic macular hole (HM-MH) with and without foveoschisis. Methods:A retrospective case controlled study. From January 2017 to February 2022, 23 eyes of 23 patients with highly myopic macular hole with and without foveoschisis diagnosed in the Shandong Eye Hospital were included in the study. Among them, 5 males had 5 eyes, and 18 females had 18 eyes, the age was (54.43±12.96) years old. The patients with or without foveoschisis were 12 eyes in 12 cases and 11 eyes in 11 cases. Studies were divided into two groups, depending on the presence of a concomitant myopic foveoschisis or not. The groups are high myopia macular hole with foveoschisis (group A) and high myopia macular hole without foveoschisis (group B). Best-corrected visual acuity (BCVA), B-scan ultrasonography, optical coherence tomography and axial length (AL) measurement were performed in all eyes. Snellen chart was used for BCVA examination, and the visual acuity was converted into logarithm of minimum angle of resolution (logMAR) during statistics. The age of the two groups, sex, macular hole (MH) diameter, logMAR BCVA, AL, posterior scleral staphyloma, there was no significant difference ( P>0.05). PPV combined with ILM peeling and C 3F 8 filling were performed in all eyes. Follow-up was at least 3 months after the last operation. BCVA changes and MH closure were compared between the two groups after surgery. Wilcoxon test was used to compare BCVA before and after operation. Mann-whiteny U test was used to compare preoperative and postoperative BCVA between groups. Results:After initial surgery, MH was closed in 17 of 23 eyes (74%, 17/23). MH was closed in 8 eyes in group A (66.7%, 8/12). Four eyes were not closed (33.3%, 4/12); MH closed in 9 eyes in group B (81.8%, 9/11). There was no significant difference between the two groups after initial operation ( P>0.05). At 1 and 3 months after surgery, the logMAR BCVA of patients in group A and group B were 1.00±0.46, 1.03±0.83 and 0.53±0.63, 0.55±0.41, respectively. Compared with before operation, there was no significant difference at 1 month ( P=0.783, 0.358), but the difference was statistically significant at 3 months ( P=0.012, 0.007). There was no significant difference in logMAR BCVA between group A and group B at 1 and 3 months after operation ( P=0.687, 0.950). Conclusion:PPV combined with ILM peeling and C 3F 8 tamponade can promote MH closure and improve visual acuity in most affected eyes with HM-MH with and without foveoschisis.
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Vitreoretinal interface is consisted of posterior vitreous cortex, retina internal limiting membrane, and extracellular matrix between them. Basement membrane-like complex is formed in the interface. The interface in children is of much difference with that in adult. The adhesion of it is much tight in children. The posterior edge of vitreous base is closed to ora serrata. The retina internal limiting membrane is thin. But with age, the posterior margin of vitreous base extends posteriorly, internal limiting membrane thickens and its elasticity decreases, the adhesion in vitreoretinal interface weakens, and posterior vitreous detachment develops. To recognize fully the interface in children is of much importance for understanding the pathophysiology and treatment strategy of pediatric vitreoretinal diseases.
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@# As a major innovation in macular surgery over the past 30 years,internal limiting membrane peeling has now become standard operation after all-round improvements. However, how to achieve optimal response and avoid poor prognosis by peeling the internal limiting membrane, which is the basement membrane of the Müller cells representing the structural interface between retina and vitreous, still needs to be explored. Prof. Peter Wiedemann, the co-editor-in-chief of our journal, in view of his long-term outstanding contributions to retinal surgery and the important progress his team has made in foveal regeneration, wrote this review with a special invitation. He gladly completed this article in 2wk, which is comprehensive, outlined, insightful, concise and shining with wisdom. It summarizes the history, rationale, techniques, indications, size and adverse outcomes of internal limiting membrane peeling and the surgery for refractory macular hole. It not only affirms current cognition, but raises existing problems, which are worthy reading and reflecting, so it was translated for readers' convenience.
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The internal limiting membrane located at vitreoretinal interface is formed by the contiguous basement membranes of Müller cells.Nowadays, vitrectomy combined with internal limiting membrane peeling has been widely used in many operations involving macular area.Although its clinical efficacy and safety have been demonstrated, it lacks the necessary histological support.At the same time, many studies have shown that the internal limiting membrane plays different roles in the occurrence of different diseases.Current studies have found that the proliferation of inflammatory cells, glial cells and vitreous cells leads to the physiological dysfunction of the vitreoretinal interface, and the internal limiting membrane can also become a scaffold for the proliferation of myofibroblasts, which will lead to the occurrence of macular diseases.This article reviewed the histological research of internal limiting membrane in terms of diabetic retinopathy, idiopathic macular hole and idiopathic macular epiretinal membrane, hoping to better understand the internal limiting membrane under pathological conditions and to confirm the safety and necessity of internal limiting membrane peeling from ultrastructure.
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AIM: To investigate the clinical efficacy of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane flap technique in the treatment of macular hole retinal detachment(MHRD)in high myopia.METHODS: A retrospective clinical study was conducted. A total of 63 patients(64 eyes)with high myopia and MHRD who treated at our hospital from October 2017 to October 2021 were selected as research subjects. They were divided into two groups according to different surgery, with 34 cases(35 eyes)who received PPV combined with inverted internal limiting membrane flap technique in group A, and 29 cases(29 eyes)received PPV combined with internal limiting membrane peeling in group B. The patients were followed up for 6mo. The two groups were compared in terms of the hole closure rate, the reduction rate of retinal detachment and best corrected visual acuity(BCVA)before operation and at 1wk, 1, 3 and 6mo after operation, and the postoperative complications were recorded.RESULTS: The hole closure rate within 6mo after operation was significantly higher in group A than in group B(P&#x003C;0.05), but there was no statistically significant difference in the reduction rate of retinal detachment(P&#x003E;0.05). The BCVA of the two groups was significantly improved over time after operation(P&#x003C;0.05). There was no statistically significant difference in BCVA between the two groups before operation and at 1wk, 1, 3 and 6mo after operation(P&#x003E;0.05). Complications were observed in the two groups, but there was no statistically significant difference in the incidence of complications between the two groups(P&#x003C;0.05).CONCLUSION: PPV combined with inverted internal limiting membrane flap technique is safe and effective in the treatment of MHRD in high myopia, which can effectively improve the patients' BCVA and the hole closure rate without influence on intraocular pressure.
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AIM: To evaluate the efficacy and safety of foveal-sparing internal limiting membrane peeling(FSIP)or complete internal limiting membrane peeling(CMIP)for the treatment of myopic traction maculopathy(MTM)during vitrectomy.METHODS: CNKI, Wanfang, VIP, PubMed, Embase, Cochrane Library, and Web of Science were searched from January 1th 2000 to July 1th 2022, and studies that compared FSIP and CMIP for MTM were collected. The change and recovery rate of best corrected visual acuity(BCVA), incidence of full-thickness macular hole(FTMH), change of central foveal thickness(CFT)and the rate of complete reattachment.RESULTS: A total of 484 eyes from 12 literatures were included, with 203 eyes in the FSIP group and 281 eyes in the CMIP group. The results of Meta-analysis showed that FSIP group were superior to the CMIP group in the mean change of BCVA(SMD=0.52, 95%CI: 0.20～0.85, P=0.002), the improvement rate of BCVA(RR=1.50, 95%CI: 1.22～1.85, P=0.0002)and the incidence of postoperative FTMH(RR=0.23, 95%CI: 0.10～0.54, P=0.0008). There was no statistical difference between the two surgical methods in terms of mean change in CFT(SMD=0.04, 95%CI: -0.19～0.26, P=0.75)and the rate of complete reattachment(RR=1.12, 95%CI: 0.94～1.32, P=0.20).CONCLUSION: FSIP have similar anatomical outcomes compared to CMIP, but FSIP resulted in better visual acuity and lower incidence of postoperative FTMH.
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Sub-internal limiting membrane hemorrhages, although uncommon, have been documented to occur in Valsalva retinopathy, blood dyscrasias, Terson syndrome, and ocular trauma. Due to their predilection for the macular region, they often lead to severe vision loss in young patients
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A 44?year?old female with a vision of 10/200 in the right eye had double pits in the temporal segment of the optic disc with serous macular detachment. Spectral?domain optical coherence tomography (SD?OCT) confirmed serous retinal detachment, an outer layer hole, and double optic disc pits. The patient underwent pars plana vitrectomy with modified ILM flap surgery involving fovea?sparing internal limiting membrane peeling (FSIP) technique with inverted ILM flap tucking with gas tamponade. Post surgery, the communications between perineural and intraretinal spaces were obliterated with flaps of ILM covering the pits, with reduced serous macular detachment and BCVA of 20/120. FSIP with inverted internal limiting membrane flap tuck can be an effective technique to manage rare cases of double ODP?M
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We demonstrate a modified internal limiting membrane (ILM) inverted flap technique for closure of macular holes (MHs) concurrent with rhegmatogenous retinal detachment in myopic eyes. Multiple ILM flaps were created in a flower?petal configuration around the MH over the detached retina after shallowing the retina as much as possible. Traction was always in a direction that allowed the optic disc to act as an anchor to limit iatrogenic breaks and to bridge the hole with multiple, more secure flaps should one of the flaps revert or break away. The technique proved safe and efficient in MH closure in our series of eight cases. The modification described provides an effective approach for challenging myopic cases in which ILM flap creation is needed over a detached retina.
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Purpose: To report a simple modification of internal limiting membrane (ILM) peeling tailored to the shape of the macular hole to improve the closure rates. Methods: This is a single?center interventional case series. conducted between 2016 and 2020. The minimum follow?up was 4 months. All surgeries were performed by one surgeon. Twenty consecutive patients (21 eyes) with large idiopathic macular holes (horizontal diameter: ?600 ?m) were enrolled; vertical hole diameters were also measured using spectral?domain optical coherence tomography (OCT). Following vitrectomy, ILM peeling was performed over a horizontally oval area (additional 1 disc?diameter temporally); perfluoropropane gas (C3F8, 15%) tamponade was used. Hole closure and change in best?corrected visual acuity (BCVA) were monitored after absorption of the gas. Preoperative and postoperative visual acuities were compared using paired t?test. IBM SPSS (ver. 26) was used for analysis. Results: The macular holes were horizontally oval rather than circular without exception: mean horizontal and vertical diameters were 714 ?m (range: 600–1020 ?m) and 602 ?m (490–844 ?m), respectively. Following vitrectomy, macular hole closure was obtained in 20/21 eyes by the last follow?up (mean: 28 months, median: 34 months; range 4–48 months). Mean Snellen BCVA improved from 20/200 to 20/63 (P < 0.0001). Conclusion: All the macular holes in the study were observed to be horizontally oval. A corresponding horizontal enlargement of the ILM rhexis yielded excellent anatomical and satisfactory visual outcomes
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@#Refractory macular hole(MH)mainly includes large MH, high myopia MH, persistent MH, recurrent MH, and traumatic MH. Compared with ordinary MH, the closure rate in patients with refractory MH through conventional vitrectomy combined with internal limiting membrane(ILM)peeling is greatly reduced. Currently, the ILM flap technique has gradually been applied for the treatment of refractory MH and achieved higher MH closure rate and better visual function recovery. The ILM flap technique has many variations, including the difference of size, shape, number, and method in which the flaps put on the MH, but each has its own advantages, disadvantages and application limitations. So far, there is no recognized standard procedure for the treatment of refractory MH. This paper reviewed the surgical methods and therapeutic effects of ILM flap technique appeared in domestic and foreign literature, which is aimed to provide a reference for the selection of clinical procedures for refractory MH by new ILM flap technique needs to be explored in the future.
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@#AIM: To evaluate the effect of vitrectomy with inverted internal limiting membrane(ILM)flap technique and air tamponade in high myopic eyes with macular hole retinal detachment(MHRD).METHODS: A retrospective, noncomparative study of high myopia patients with MHRD was conducted. In all cases, triamcinolone acetonide was used to visualize the vitreous during vitrectomy. After ILM was inverted, a venous blood clot was placed on the inverted ILM flap and air was used as tamponade. Macular hole closure rate, retinal reattachment rate, and postoperative best-corrected visual acuity(BCVA)were assessed after the surgery.RESULTS: Twenty-four eyes of 24 high myopia patients with MHRD were included in this study. The patients were followed up for at least 6mo, averaging 13.58±7.00mo. At last follow up,macular hole(MH)was closed in 21 eyes(88%)and retina was reattached in 20 eyes(83%). Seventeen eyes(71%)had both complete MH closure and retinal reattachment. Three eyes(13%)had complete reattached retina with unclosed MH, while 4 eyes(17%)had persistent subretinal fluid with closed MH. No additional pars plana vitrectomy(PPV)was performed. BCVA(LogMAR)was significantly improved at last follow up(0.65±0.34 <i>vs</i> 1.36±0.49, <i>P</i><0.001). An improvement in BCVA of 2 or more lines was achieved in 12 eyes(50%).CONCLUSION:Vitrectomy combined with inverted ILM flap, autologous blood transplantation and air tamponate is an effective treatment for MHRD in myopic eyes.
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@#AIM: To observe the difference of curative effect between internal limiting membrane(ILM)inversion and insertion and ILM peeling and to analyze the influence of different surgical methods on the morphology of hiatus healing.<p>METHODS: A retrospective analysis of the clinical data of 22 patients with macular hole, who received vitrectomy in the First People's Hospital of Zunyi City from June 2017 to June 2020. According to the surgical methods, they were divided into 8 cases and 8 eyes in the ILM peeling group and 14 cases and 14 eyes in the ILM inversion covering group. The two groups of patients underwent best corrected visual acuity(BCVA)test, non-contact intraocular pressure and optical coherence tomography(OCT)examination before and 1wk, 1, and 3mo after operation were analysed. <p>RESULTS: The macular hole closure rate in the ILM peeling group was 75%, and the hole closure rate in the ILM inversion and insertion group was 93%. There was no statistically significant difference in the hole closure rate between the two groups(P=0.527). The trends of BCVA over time in the two groups were similar, but there were differences in time(Ftime=18.426, Ptime<0.001)and no difference between groups and interactions(Fbetween groups=1.319, Pbetween groups=0.289; Fbetween groups×time=1.658, Pbetween groups×time=0.211). The BCVA of the two groups was statistically significant 1wk after operation compared with that before operation(t= -2.200, -3.092; all P<0.05); The BCVA of the ILM inversion and insertion group was improved 3mo after operation compared with that before operation, and the difference in the group was statistically significant(t=2.503, P=0.019). There was no difference in overall foveal thickness between the two groups after surgery(Ftime=1.054, Ptime=0.346; Fbetween groups=0.110, Pbetween groups=0.750; Fbetween groups×time=2.391, Pbetween groups×time=0.152).<p>CONCLUSION: Both ILM inversion and insertion and ILM peeling can effectively increase the rate of macular hole closure. The macular structure healing after the ILM inversion and insertion is better, and the postoperative visual function improvement is more satisfactory.
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@#AIM:To investigate the efficacy and safety of pars plana vitrectomy(PPV)combined with inverted internal limiting membrane(ILM)flap and PPV combined with ILM tamping in the treatment of large basal diameter idiopathic macular hole(IMH), and to analyze the correlation between postoperative visual acuity and preoperative parameters. <p>METHODS:This study is a retrospective clinical study. Totally 56 patients(57 eyes)with macular hole bottom diameter greater than 1 000μm, who treated in Joint Shantou International Eye Center from January 2018 to December 2020, were enrolled in this study. Thirty eyes were involved in PPV combined with inverted ILM flap(Group 1)and 27 eyes were involved in PPV combined with ILM tamping(Group 2). The best corrected visual acuity(BCVA), the closure of the macular hole, thickness of foveal neurosensory layer and complications were compared between the two groups at 1wk and 1mo after the surgery. Person correlation analysis was used to explore the correlation between preoperative parameters and BCVA at 1mo after operation.<p>RESULTS: There was no significant difference in gender, age, eye type, course of disease, preoperative BCVA, postoperative macular hole healing classification, preoperative hole bottom diameter and eye axis between the two groups(P>0.05). The closure rate of macular hole in Group 1 was 97%, of which type 1 closure was 80%. The closure rate of macular hole in Group 2 was 100%, of which type 1 closure was 78%, and there was no significant difference in the closure rate(P=0.99). The postoperative follow-up BCVA of patients in both groups was better than that before operation(all P<0.01). The BCVA of Group 1 was better than Group 2 at 1mo after operation, and the difference was statistically significant(t= -2.20, P=0.03). There was no significant difference in the thickness of foveal neurosensory layer between two groups at 1mo after operation(t=0.407, P=0.69). The BCVA at 1mo after operation was positively correlated with the hole diameter and preoperative BCVA(r=0.435, P=0.004; r=0.440, P=0.001). There was no complication in both groups during and after operation. <p>CONCLUSION:PPV combined with inverted ILM flap and PPV combined with ILM tamping can improve the closure rate of the hole. The long-term visual acuity of PPV combined with inverted ILM flap is better than that of PPV combined with ILM tamping. There is a significant positive correlation between postoperative BCVA and the bottom diameter of the hole and preoperative BCVA. Preoperative bottom diameter can be used as one of the basis for clinical prognosis.
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Objective:To observe the efficacy of platelet-rich fibrin (PRF) membrane tamponade combined with air filling for giant macular hole (MH).Methods:A prospective case-control study. From January 2019 to February 2021, 56 patients (56 eyes) diagnosed with giant MH from Eye Center of Renmin Hospital of Wuhan University were enrolled. Among them, there were 17 males with 17 eyes and 39 females with 39 eyes. The average age of the patients was 64.23±9.30 years old. The average MH minimum diameter was 827.36±83.16 μm. The best corrected visual acuity (BCVA) and optical coherence tomography angiography (OCTA) examination were performed before surgery. The Chinese version of 25-item National Eye Institute visual functioning questionnaire (NEI VFQ-25) was used to investigate patient's visual-related quality of life. There were 28 eyes of 28 cases receiving PRF membrane covering, as PRF group, another 28 eyes of 28 cases receiving inverted internal limiting membrane (ILM) insertion into giant MH, as ILM group. The differences of the age ( t=-1.588), sex ratio ( χ2=0.760), BCVA ( Z=-0.400), macular hole minimum diameter ( t=-0.604), choriocapillary blood flow area (CBFA) ( t=1.331) and NEI VFQ-25 score ( t=0.921) were not statistically significant ( P>0.05). All eyes underwent 23G minimally invasive vitrectomy. In the PRF group, PRF membrane was used to fill the hole, and in the ILM group, the hole was filled with ILM inversion, and filled with sterile air after full gas-liquid exchange. The follow-up time after surgery was ≥6 months. The same equipment and methods as before surgery were used to conduct related examinations, and the changes of BCVA, the shape of hole closure, CBFA and the improvement of vision-related quality of life were compared between the two groups. For comparison between groups, independent samples t-test was used for data with normal distribution, and Mann-Whitney U test was used for data with non-normal distribution. For intra-group comparisons, paired-samples t-test was used for data with normal distribution, and Wilcoxon rank-sum test was used for non-normally distributed data. Results:Six months after surgery, in the eyes of PRF group and ILM group, the hole of 27 (96.4%, 27/28) and 26 (92.6%, 26/28) eyes were closed; the median BCVA was 0.70 and 0.70, respectively; CBFA were 1.99±0.20 and 1.91±0.18 mm 2; NEI VFQ-25 scores were 81.36±12.39 and 78.39±10.12, respectively. Compared with before surgery, the BCVA ( Z=-4.636,-4.550) and CBFA ( t=-27.115,-31.135) of the affected eyes in the PRF group and ILM group were significantly improved after surgery, and the NEI VFQ-25 scores ( t=-15.557, -10.675) was significantly increased, and the difference was statistically significant ( P<0.05). There was no significant difference in BCVA ( Z=-0.167), CBFA ( t=1.554), and NEI VFQ-25 scores ( t=0.980) between the two groups after interocular surgery ( P=0.726, 0.126, 0.331). Conclusion:PRF membrane insertion with air filling has the same efficacy as ILM insertion in the treatment of giant MH, which can improve the closure rate of MH, patients' vision and vision-related quality of life, and increase choroidal blood perfusion.
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Objective:To observe the treatment effect of 25-gauge pars plana vitretomy with the inverted internal limiting membrane (ILM) flap and autologous serum coverage in high myopia macular hole (HMMH) eyes.Methods:17 patients (17 eyes) with HMMH were selected from the Affiliated Hospital of Chinese Medicine Hospital of Xinjiang Medical University from June 2019 to March 2020. The minimum diameter of macular hole in all patients was ≤500 μm. They were diveded into group A (10 eyes) and group B (7 eyes) according to the random number table method. The group A underwent 25-gauge pars plana vitretomy + inverted ILM falp technique + autologous serum coverage; The group B (5 eyes) underwent 25-gauge pars plana vitretomy with ILM peeling technique. The best corrected visual acuity (BCVA) before and after surgey and the macualr hole closure rates were observed.Results:There was no significant difference in BCVA between the two groups before operation and at 6 months after operation ( P>0.05); The postoperative macular hole closure rate was 8/10 in group A and 4/7 in group B. There was no significant difference in macular hole closure rate between the two groups ( P>0.05); The BCVA of the two groups at the last follow-up after operation was significantly higher than that before operation ( P<0.05). Conclusions:Vitrectomy combined with inverted ILM falp technique is a safe and effective method in the treatment of high myopia macular hole with diameter ≤500 μm.
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Objective:To analyze the effect of vitrectomy combined with internal limiting membrane (ILM) peeling on the prevention of post-vitrectomy epiretinal membrane (ERM) in macular-off rhegmatogenous retinal detachment (RRD) and its influence on visual outcomes.Methods:A cohort study was conducted.Seventy-four patients (74 eyes) with macular-off RRD, who realized retinal reattachment after vitrectomy and silicone oil tamponade from January 2015 to January 2018 in Baoding NO.1 Central Hospital, were enrolled.The patients were divided into the non-ILM peeling group (36 cases, 36 eyes) and ILM peeling group (38 cases, 38 eyes) according to whether they received ILM peeling or not.The patients underwent silicone oil removal within 3 to 5 months after the surgery.Best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscopy, fundus photography and optical coherence tomography (OCT) were examined before and at 1, 6 and 12 months after the surgery.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Baoding NO.1 Central Hospital (No.[2019]042). Written informed consent was obtained from each patient.Results:There was no ERM found in the two groups at 1 month after the operation.There were 3 eyes (8.33%) with ERM in the non-ILM peeling group and 2 eyes (5.26%) in the ILM peeling group at 6 months after the operation, with no statistically significant difference between them ( P=0.067). There were 9 eyes (25.00%) with ERM in the non-ILM peeling group and 4 eyes (10.53%) in the ILM peeling group at 12 months postoperatively, with no statistically significant difference between them ( χ2=2.674, P=0.102). There was a significant difference in BCVA between before and after the operation in the two groups ( Ftime=31.692, P<0.001). Postoperative 1-, 6-and 12-month BCVA were all significantly better than the preoperative BCVA in the two groups (all at P<0.05). There was no significant difference in BCVA between the two groups ( Fgroup=0.117, P=0.773). OCT images showed that there were 25 eyes (77.78%) and 30 eyes (78.95%) with the intact ellipsoid zone in the non-ILM peeling group and ILM peeling group at 12 months after the operation, respectively, with no statistically significant difference between them ( χ2=0.875, P=0.350). Conclusions:Compared with vitrectomy alone, the vitrectomy combined with ILM peeling does not show better efficacy in the prevention of ERM occurrence in macula-off RRD patients and has no obvious influence on postoperative visual acuity.
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Objective:To systematically evaluate the effect of pars plana vitrectomy (PPV) combined total peeling of internal limiting membrane (ILM) versus fovea-sparing peeling of ILM for myopic foveoschisis.Methods:A evidence-based medicine study. Chinese and English as search terms for myopic foveoschisis, vitrectomy, and peeling of internal limiting membrane were used to search literature in China National Knowledge Infrastructure, Wanfang database, VIP database, PubMed of National Library of Medicine, Medline, Embase, and Cochrane Library. The high myopic macular schisis was selected as the research object, the intervention method was PPV combined with complete ILM peeling and combined with foveal preservation ILM peeling surgery clinical control study between Jan 1, 2010, and Jun 31, 2021. Incomplete or irrelevant literature and review literature were excluded. The method of Newcastle-Ottawa Scale system was used to evaluate the included literature. The literature was meta-analyzed by RevMan5.3 software. The mean difference ( MD) and a confidence interval ( CI) of 95% were used to describe the effect sizes of continuous data, fixed effects model was performed. The data including the best corrected visual acuity (BCVA), central fovea thickness (CFT), and postoperative macular hole (MH) were analyzed. Results:In those databases, 232 articles based search stratery were totally retrieved, and 10 articles (417 eyes) were finally included for meta-analysis with 245 eyes for PPV combined total peeling of ILM and 172 eyes for PPV combined fovea-sparing peeling of ILM. Meta-analysis results showed there was no significant difference in BCVA and CFT between the two groups (BCVA: MD=0.05, 95% CI 0.00-0.11; P>0.05; CFT: MD=-4.79, 95% CI -18.69-9.11, P>0.05). It was compared with the incidence of MH, the difference was statistically significant (odds ratio=5.70, 95% CI 2.22-14.61, P<0.05). Conclusion:BCVA and CFT could be improved by PPV combined total and fovea-sparing peeling of ILM for myopic foveoschisis; compared with complete ILM peeling, the incidence of MH was lower after foveal-sparing ILM peeling.