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Meta-Analysis
. 2021 Mar 5;16(3):e0246667.
doi: 10.1371/journal.pone.0246667. eCollection 2021.

Primary vitrectomy for degenerative and tractional lamellar macular holes: A systematic review and meta-analysis

Guglielmo Parisi  1 , Matteo Fallico  1 , Andrea Maugeri  2 , Martina Barchitta  2 , Antonella Agodi  2 , Andrea Russo  1 , Antonio Longo  1 , Teresio Avitabile  1 , Niccolò Castellino  1 , Vincenza Bonfiglio  3 , Roberto Dell'Omo  4 , Claudio Furino  5 , Gilda Cennamo  6 , Robert Rejdak  7 , Katarzyna Nowomiejska  7 , Mario Toro  7 , Paola Marolo  8 , Luca Ventre  8 , Michele Reibaldi  8
Affiliations
Meta-Analysis

Primary vitrectomy for degenerative and tractional lamellar macular holes: A systematic review and meta-analysis

Guglielmo Parisi et al. PLoS One. .

Abstract

Purpose: To assess the efficacy of vitrectomy in degenerative and tractional lamellar macular holes (LMHs) by meta-analysis of published studies.

Methods: PubMed, Medline and Embase databases were searched up to May 2020. Included cohorts were divided into three groups: degenerative LMH group, lamellar hole associated epiretinal proliferation (LHEP) group and tractional LMH group. LHEP is likely to be associated with degenerative LMHs, but less commonly could be associated with mixed LMHs. To reduce risk of possible misclassification bias, eyes with LHEP which could not have been precisely classified by the authors, were included into the LHEP group. The primary outcome was to investigate the visual change following primary vitrectomy in the degenerative LMH and LHEP group versus the tractional LMH group. A sensitivity analysis excluding the LHEP group was also performed on the primary outcome. Mean difference (MD) in best corrected visual acuity between baseline and post-treatment was calculated, along with 95% confidence interval (CI). Rate of incidence of post-operative full-thickness macular hole (FTMH) was assessed as secondary outcome.

Results: Thirteen studies were included. Pooled analyses including all groups showed a significant visual improvement following vitrectomy (pre-post MD = -0.17;95%CI = -0.22,-0.12;p<0.001), with no difference in visual improvement between the degenerative LMH and LHEP group and the tractional LMH group. The sensitivity analysis excluding LHEP group confirmed no difference in visual change between the degenerative LMH group (pre-post MD = -0.18;95%CI = -0.24,-0.12;p<0.001) and the tractional LMH group (MD = -0.16;95%CI = -0.26,-0.07;p<0.001). The incidence rate of post-operative FTMH was higher in the degenerative LMH and LHEP group than in the tractional LMH group (p = 0.002).

Conclusion: Primary vitrectomy for LMH ensured a favorable visual outcome, with no difference in visual gain between degenerative and tractional LMHs. However, a higher incidence of post-operative FTMHs was found in eyes with the degenerative LMH subtype.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart of study selection process.
From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Iterns for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(7): e1000097. doi: 10.1371/journal.pmed1000097 For more information, visit www.prisma-statement.org.
Fig 2
Fig 2. A forest plot showing pre-post mean difference in BCVA in the degenerative LMH and LHEP group versus the tractional LMH group.
Fig 3
Fig 3. A forest plot showing pre-post mean difference in BCVA in the degenerative LMH group versus the tractional LMH group.
Fig 4
Fig 4. Cumulative meta-analysis (A) and meta-regression (B) showing relationship between patient age and pre-post mean difference in BCVA in the degenerative LMH and LHEP group.
Fig 5
Fig 5. Meta-regression showing no significant effect of follow-up duration on pre-post mean difference in BCVA in the degenerative LMH and LHEP group (A) and in tractional LMHs (B).
See this image and copyright information in PMC

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References

    1. Pal E, Givort G, Laroche A, Barale PO, Limon S, Ullern M. [Macular imaging with optical coherence tomography]. J fran{ç}ais d’ophtalmologie. 1998. - PubMed
    1. Parolini B, Schumann RG, Cereda MG, Haritoglou C, Pertile G. Lamellar macular hole: A clinicopathologic correlation of surgically excised epiretinal membranes. Investig Ophthalmol Vis Sci. 2011;52: 9074–9083. 10.1167/iovs.11-8227 - DOI - PubMed
    1. Govetto A, Dacquay Y, Farajzadeh M, Platner E, Hirabayashi K, Hosseini H, et al.. Lamellar Macular Hole: Two Distinct Clinical Entities? Am J Ophthalmol. 2016;164: 99–109. 10.1016/j.ajo.2016.02.008 - DOI - PubMed
    1. Figueroa MS, Govetto A, Steel DH, Sebag J, Virgili G, Hubschman JP. PARS PLANA VITRECTOMY for the TREATMENT of TRACTIONAL and DEGENERATIVE LAMELLAR MACULAR HOLES: Functional and Anatomical Results. Retina. 2019;39: 2090–2098. 10.1097/IAE.0000000000002326 - DOI - PubMed
    1. dell’Omo R, dell’Omo E, Costagliola C, Costagliola C. Role of Lamellar Hole–Associated Epiretinal Proliferation in Lamellar Macular Holes. Am J Ophthalmol. 2017;175: 16–29. 10.1016/j.ajo.2016.11.007 - DOI - PubMed