BMC Ophthalmology (Apr 2025)

Critical analysis of macular hole repair techniques: a comprehensive systematic review and meta-analysis comparing internal limiting membrane flap and internal limiting membrane peeling for any size of macular hole

  • Syed Muhammad Muneeb Akhtar,
  • Syed Zia Saleem,
  • Syed Ali Asad Rizvi,
  • Areeba Fareed,
  • Munazza Mumtaz,
  • Shiza Saleem,
  • Anusha Bai,
  • Afsana Ansari Shaik,
  • Robert Kirchoff,
  • Muhammad Sohaib Asghar

DOI
https://doi.org/10.1186/s12886-025-04011-0
Journal volume & issue
Vol. 25, no. 1
pp. 1 – 15

Abstract

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Abstract Background Macular holes (MHs) are a leading cause of visual impairment and blindness worldwide defined as a partial or full thickness anatomical defect in the fovea of the retina. ILM peeling is an effective surgical procedure to repair the defect. However, this approach lacks efficacy for larger macular holes. ILM flap is a novel technique with demonstrated efficacy for repair of larger defects. Objective This systematic review and meta-analysis aims to compare the effectiveness of these two techniques in treating any size and type of MH. Methods A comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were MH closure rate and postoperative VA. The statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Pooled odds ratios (ORs), mean differences (MD), and 95% confidence intervals (CIs) were calculated. All statistical analyses were performed using R Statistical Software and meta package v4.17-0. Results A total of thirty-two studies, comprising nine RCTs and twenty three retrospective studies were included in this meta-analysis, which involved 1220 eyes in the ILM flap group and 1277 eyes in the ILM peeling group. The overall MH closure rate significantly favored ILM flap technique (OR = 2.47, CI = 1.58 to 3.87; P 400 μm (MD = -0.13, 95% CI = -0.17 to -0.08, p < 0.01; I2 = 13%), as well as on subgrouping based on follow-up duration (MD = -0.11, 95% CI = -0.14 to -0.08, p < 0.01; I2 = 25%). Conclusion ILM flap technique resulted in significantly better closure rate with all sizes of MHs, coupled with improved visual acuity in larger MHs and with follow-up duration.

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