Internal limiting membrane peeling or not: a systematic review and meta-analysis of idiopathic macular pucker surgery.
To determine whether internal limiting membrane (ILM) peeling improves anatomical and functional outcomes in idiopathic macular pucker (IMP)/epiretinal membrane (ERM) surgery in this systematic review and meta-analysis.



We searched the PubMed, Medline, Web of Science, Cochrane, Ovid MEDLINE, ClinicalTrials.gov and CNKI databases for studies published before 15 September 2016. The eligibility criteria included studies comparing ILM peeling versus no-peeling for IMP surgery.



Thirteen articles (10 retrospective cohort studies, 1 prospective cohort study and 2 randomised controlled trials (RCTs)) were included in the review. Primary outcomes: no differences were observed in the best-corrected visual acuity (BCVA) or central macular thickness (CMT) at 12 months; however, lower ERM recurrence (OR, 0.13; 95% CI 0.04 to 0.41; p=0.0004) and reoperation rates (OR, 0.10; 95% CI 0.02 to 0.49; p=0.004) that favoured ILM peeling were observed at the final follow-up.



no difference was observed in BCVA at 3, 6 months, the final follow-up or in CMT at 3, 6 months, the final follow-up. Significantly increased CMT, which favoured ILM peeling, was observed at the final follow-up (p=0.002) in the RCTs.



ILM peeling yielded greater anatomical success, but no improvement in functional outcomes as the treatment of choice for patients undergoing IMP surgery.
Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai, China.
Xiao-Ling
XL
Fang
Department of Ophthalmology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Yao
Y
Tong
Department of Ophthalmology, The Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Ya-Li
YL
Zhou
Department of Ophthalmology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Pei-Quan
PQ
Zhao
Department of Ophthalmology, The Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Zhao-Yang
ZY
Wang
D001485:Basement Membrane / Q000601:surgery*; D019773:Epiretinal Membrane / Q000601:surgery*; D006801:Humans; D008266:Macula Lutea / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*
Retina; Treatment Surgery