title: Vitrectomy with internal limiting membrane peeling versus no peeling for idiopathic full-thickness macular hole.
abstract: OBJECTIVE
  To determine whether internal limiting membrane (ILM) peeling improves anatomic and functional outcomes of full-thickness macular hole (FTMH) surgery when compared with the no-peeling technique.
  
  
  METHODS
  Systematic review and individual participant data (IPD) meta-analysis undertaken under the auspices of the Cochrane Eyes and Vision Group. Only randomized controlled trials (RCTs) were included.
  
  
  METHODS
  Patients with idiopathic stage 2, 3, and 4 FTMH undergoing vitrectomy with or without ILM peeling.
  
  
  METHODS
  Macular hole surgery, including vitrectomy and gas endotamponade with or without ILM peeling.
  
  
  METHODS
  Primary outcome was best-corrected distance visual acuity (BCdVA) at 6 months postoperatively. Secondary outcomes were BCdVA at 3 and 12 months; best-corrected near visual acuity (BCnVA) at 3, 6, and 12 months; primary (after a single surgery) and final (after >1 surgery) macular hole closure; need for additional surgical interventions; intraoperative and postoperative complications; patient-reported outcomes (PROs) (EuroQol-5D and Vision Function Questionnaire-25 scores at 6 months); and cost-effectiveness.
  
  
  RESULTS
  Four RCTs were identified and included in the review. All RCTs were included in the meta-analysis; IPD were obtained from 3 of the 4 RCTs. No evidence of a difference in BCdVA at 6 months was detected (mean difference, -0.04; 95% confidence interval [CI], -0.12 to 0.03; P=0.27); however, there was evidence of a difference in BCdVA at 3 months favoring ILM peeling (mean difference, -0.09; 95% CI, -0.17 to-0.02; P=0.02). There was evidence of an effect favoring ILM peeling with regard to primary (odds ratio [OR], 9.27; 95% CI, 4.98-17.24; P<0.00001) and final macular hole closure (OR, 3.99; 95% CI, 1.63-9.75; P=0.02) and less requirement for additional surgery (OR, 0.11; 95% CI, 0.05-0.23; P<0.00001), with no evidence of a difference between groups with regard to intraoperative or postoperative complications or PROs. The ILM peeling was found to be highly cost-effective.
  
  
  CONCLUSIONS
  Available evidence supports ILM peeling as the treatment of choice for patients with idiopathic stage 2, 3, and 4 FTMH.
authors: Ophthalmology Department, Grampian University Hospitals NHS Trust, Aberdeen, United Kingdom.
authors: Kurt
authors: K
authors: Spiteri Cornish
authors: Centre for Vision and Vascular Science, Queens University, Belfast, Northern Ireland. Electronic address: n.lois@qub.ac.uk.
authors: Noemi
authors: N
authors: Lois
authors: Medical Statistics Team, University of Aberdeen, Aberdeen, United Kingdom.
authors: Neil W
authors: NW
authors: Scott
authors: School of Medicine, Medical and Biological Sciences Building, University of St. Andrews, Fife, United Kingdom.
authors: Jennifer
authors: J
authors: Burr
authors: Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom.
authors: Jonathan
authors: J
authors: Cook
authors: Ophthalmology, Assistance Hopitaux Publique de Paris, Paris, France.
authors: Charles
authors: C
authors: Boachie
authors: Ophthalmology, Assistance Hopitaux Publique de Paris, Paris, France.
authors: Ramin
authors: R
authors: Tadayoni
authors: Ophthalmology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Morten
authors: M
authors: la Cour
authors: Ophthalmology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
authors: Ulrik
authors: U
authors: Christensen
authors: Department of Ophthalmology, Hong Kong Sanatorium and Hospital, Hong Kong, China.
authors: Alvin K H
authors: AK
authors: Kwok
mesh_terms: D001485:Basement Membrane / Q000601:surgery*; D058450:Endotamponade; D019773:Epiretinal Membrane / Q000601:surgery*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012167:Retinal Perforations / Q000503:physiopathology / Q000601:surgery*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology; D014821:Vitrectomy