BACKGROUND The purpose of this study was to compare the anatomical and visual outcomes of inverted internal limiting membrane (ILM) flap technique and internal limiting membrane peeling in large macular holes (MH). METHODS Related studies were reviewed by searching electronic databases of Pubmed, Embase, Cochrane Library. We searched for articles that compared inverted ILM flap technique with ILM peeling for large MH (> 400 μm). Double-arm meta-analysis was performed for the primary end point that was the rate of MH closure, and the secondary end point was postoperative visual acuity (VA). Heterogeneity, publication bias, sensitivity analysis and subgroup analysis were conducted to guarantee the statistical power. RESULTS This review included eight studies involving 593 eyes, 4 randomized control trials and 4 retrospective studies. After sensitivity analysis for eliminating the heterogeneity of primary outcome, the pooled data showed the rate of MH closure with inverted ILM flap technique group was statistically significantly higher than ILM peeling group (odds ratio (OR) = 3.95, 95% confidence interval (CI) = 1.89 to 8.27; P = 0.0003). At the follow-up duration of 3 months, postoperative VA was significantly better in the group of inverted ILM flap than ILM peeling (mean difference (MD) = - 0.16, 95% CI = - 0.23 to 0.09; P < 0.00001). However, there was no difference in visual outcomes between the two groups of different surgical treatments at relatively long-term follow-up over 6 months (MD = 0.01, 95% CI = - 0.12 to 0.15; P = 0.86). CONCLUSION Vitrectomy with inverted ILM flap technique had a better anatomical outcome than ILM peeling. Flap technique also had a signifcant visual gain in the short term, but the limitations in visual recovery at a longer follow-up was found.

中文翻译：

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倒置内膜限制瓣技术与大黄斑裂孔内膜剥离的比较疗效评估：系统评价和荟萃分析。

背景技术本研究的目的是比较倒置内膜（ILM）瓣技术和大黄斑孔（MH）内膜剥离的解剖学和视觉效果。方法通过检索Pubmed，Embase，Cochrane图书馆的电子数据库对相关研究进行综述。我们搜索的文章比较了较大的MH（> 400μm）的反向ILM皮瓣技术与ILM剥皮。臂荟萃分析的主要终点是MH闭合率，次要终点是术后视力（VA）。进行异质性，发表偏倚，敏感性分析和亚组分析以确保统计能力。结果该评价包括八项涉及593只眼的研究，四项随机对照试验和四项回顾性研究。经过敏感性分析以消除主要结局的异质性后，汇总数据显示，倒置ILM皮瓣技术组的MH闭合率在统计学上显着高于ILM剥离组（优势比（OR）= 3.95，95％置信区间（CI）） = 1.89至8.27； P = 0.0003）。在3个月的随访期中，反转ILM皮瓣组的术后VA明显优于ILM剥离（平均差（MD）=-0.16，95％CI =-0.23至0.09； P <0.00001）。但是，在经过6个月的长期随访后，两组不同手术治疗的视觉效果没有差异（MD = 0.01，95％CI =-0.12至0.15； P = 0.86）。结论玻璃体切除术采用反向ILM皮瓣技术比ILM剥离具有更好的解剖学结局。