Vitrectomy with Internal Limiting Membrane Peeling versus No Peeling for Idiopathic Full-Thickness Macular Hole

Kurt Spiteri Cornish; Noemi Lois; Neil W Scott; Jennifer Burr; Jonathan Cook; Charles Boachie; Ramin Tadayoni; Morten la Cour; Ulrik Christensen; Alvin K H Kwok

doi:10.1016/j.ophtha.2013.10.020

Vitrectomy with Internal Limiting Membrane Peeling versus No Peeling for Idiopathic Full-Thickness Macular Hole

Kurt Spiteri Cornish, Noemi Lois, Neil W Scott, Jennifer Burr, Jonathan Cook, Charles Boachie, Ramin Tadayoni, Morten la Cour, Ulrik Christensen, Alvin K H Kwok

Department of Clinical Medicine

108 Citations (Scopus)

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. Design 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. Participants and Controls Patients with idiopathic stage 2, 3, and 4 FTMH undergoing vitrectomy with or without ILM peeling. Intervention Macular hole surgery, including vitrectomy and gas endotamponade with or without ILM peeling. Main Outcome Measures 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.

Original language	English
Journal	Ophthalmology
Volume	121
Issue number	3
Pages (from-to)	649-655
Number of pages	7
ISSN	0161-6420
DOIs	https://doi.org/10.1016/j.ophtha.2013.10.020
Publication status	Published - Mar 2014

Keywords

Basement Membrane
Endotamponade
Epiretinal Membrane
Humans
Questionnaires
Randomized Controlled Trials as Topic
Retinal Perforations
Sickness Impact Profile
Treatment Outcome
Visual Acuity
Vitrectomy

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10.1016/j.ophtha.2013.10.020

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@article{b333b16d0db14530a536cdfcb6e52d63,

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. Design 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. Participants and Controls Patients with idiopathic stage 2, 3, and 4 FTMH undergoing vitrectomy with or without ILM peeling. Intervention Macular hole surgery, including vitrectomy and gas endotamponade with or without ILM peeling. Main Outcome Measures 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.",

keywords = "Basement Membrane, Endotamponade, Epiretinal Membrane, Humans, Questionnaires, Randomized Controlled Trials as Topic, Retinal Perforations, Sickness Impact Profile, Treatment Outcome, Visual Acuity, Vitrectomy",

author = "{Spiteri Cornish}, Kurt and Noemi Lois and Scott, {Neil W} and Jennifer Burr and Jonathan Cook and Charles Boachie and Ramin Tadayoni and {la Cour}, Morten and Ulrik Christensen and Kwok, {Alvin K H}",

year = "2014",

month = mar,

doi = "10.1016/j.ophtha.2013.10.020",

language = "English",

volume = "121",

pages = "649--655",

journal = "Ophthalmology",

issn = "0161-6420",

publisher = "Elsevier",

number = "3",

}

TY - JOUR

T1 - Vitrectomy with Internal Limiting Membrane Peeling versus No Peeling for Idiopathic Full-Thickness Macular Hole

AU - Spiteri Cornish, Kurt

AU - Lois, Noemi

AU - Scott, Neil W

AU - Burr, Jennifer

AU - Cook, Jonathan

AU - Boachie, Charles

AU - Tadayoni, Ramin

AU - la Cour, Morten

AU - Christensen, Ulrik

AU - Kwok, Alvin K H

PY - 2014/3

Y1 - 2014/3

N2 - 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. Design 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. Participants and Controls Patients with idiopathic stage 2, 3, and 4 FTMH undergoing vitrectomy with or without ILM peeling. Intervention Macular hole surgery, including vitrectomy and gas endotamponade with or without ILM peeling. Main Outcome Measures 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.

AB - 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. Design 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. Participants and Controls Patients with idiopathic stage 2, 3, and 4 FTMH undergoing vitrectomy with or without ILM peeling. Intervention Macular hole surgery, including vitrectomy and gas endotamponade with or without ILM peeling. Main Outcome Measures 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.

KW - Basement Membrane

KW - Endotamponade

KW - Epiretinal Membrane

KW - Humans

KW - Questionnaires

KW - Randomized Controlled Trials as Topic

KW - Retinal Perforations

KW - Sickness Impact Profile

KW - Treatment Outcome

KW - Visual Acuity

KW - Vitrectomy

U2 - 10.1016/j.ophtha.2013.10.020

DO - 10.1016/j.ophtha.2013.10.020

M3 - Journal article

C2 - 24314837

SN - 0161-6420

VL - 121

SP - 649

EP - 655

JO - Ophthalmology

JF - Ophthalmology

IS - 3

ER -

Vitrectomy with Internal Limiting Membrane Peeling versus No Peeling for Idiopathic Full-Thickness Macular Hole

Abstract

Keywords

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