Inverted internal limiting membrane flap technique versus internal limiting membrane peeling for large macular holes: A meta-analysis of randomized controlled trials

Inverted ILM flap technique versus conventional ILM peeling for idiopathic large macular holes: A meta-analysis of randomized controlled trials

PLoS ONE ◽

10.1371/journal.pone.0236431 ◽

2020 ◽

Vol 15 (7) ◽

pp. e0236431 ◽

Cited By ~ 1

Author(s):

Guohai Chen ◽

Radouil Tzekov ◽

Fangzheng Jiang ◽

Sihong Mao ◽

Yuhua Tong ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Ilm Peeling ◽

Flap Technique ◽

Randomized Controlled ◽

Macular Holes

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Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

BMC Ophthalmology ◽

10.1186/s12886-019-1271-2 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 6

Author(s):

Yu Shen ◽

Xiaoqin Lin ◽

Luyi Zhang ◽

Miaoqin Wu

Keyword(s):

Sensitivity Analysis ◽

Meta Analysis ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Visual Outcomes ◽

Flap Technique ◽

Macular Holes

Abstract 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.

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Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

10.21203/rs.2.14564/v2 ◽

2019 ◽

Author(s):

Yu Shen ◽

Xiaoqin Lin ◽

Luyi Zhang ◽

Miaoqin Wu

Keyword(s):

Sensitivity Analysis ◽

Meta Analysis ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Visual Outcomes ◽

Flap Technique ◽

Macular Holes

Abstract 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. Keywords: Inverted internal limiting membrane flap technique, Internal limiting membrane peeling, Large macular hole, Meta-analysis

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Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

10.21203/rs.2.14564/v4 ◽

2019 ◽

Author(s):

Yu Shen ◽

Xiaoqin Lin ◽

Luyi Zhang ◽

Miaoqin Wu

Keyword(s):

Sensitivity Analysis ◽

Meta Analysis ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Visual Outcomes ◽

Flap Technique ◽

Macular Holes

Abstract 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. Keywords: Inverted internal limiting membrane flap technique, Internal limiting membrane peeling, Large macular hole, Meta-analysis

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Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials

BMC Ophthalmology ◽

10.1186/s12886-019-1272-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Ting Ye ◽

Ji-guo Yu ◽

Lin Liao ◽

Lan Liu ◽

Ting Xia ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Macular Hole ◽

Meta Analysis ◽

Cochrane Review ◽

Internal Limiting Membrane ◽

The Elderly ◽

Cochrane Library ◽

Controlled Trials ◽

Closure Rate ◽

Randomized Controlled

Abstract Background After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomfortable and inconvenient for the elderly and those with medical comorbidities; it may also lead to certain postoperative complications. Hence, this study aimed to evaluate and compare the effect of postoperative FDP and non-face-down position (nFDP) on the closure rate of MHs following MH surgery. Methods Randomized controlled trials (RCTs) were selected through an electronic search of the Cochrane Library, Pubmed, and Embase databases. Trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary measures included overall MH closure rate and subgroup analysis based on MH size. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Statistical analysis was performed using RevMan 5.0 software and Stata software 15.0. Results Five RCTs composed of a total of 183 eyes in the FDP group and 175 eyes in the nFDP group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the FDP group was significantly higher than that in the nFDP group (OR = 2.27, 95% CI: 1.02 to 5.05, P = 0.04). For MH sizes smaller than 400 μm, the subgroup meta-analysis indicated that the closure rate of the FDP group was not significantly higher than that of the nFDP group (OR = 1.32, 95% CI: 0.39 to 4.49, P = 0.66). However, when MH size was larger than 400 μm, there was a significantly higher closure rate in the FDP group (OR = 2.95, 95% CI: 1.10 to 7.94, P = 0.03). Conclusions Our results provide evidence that a face-down postoperative position seems to be unnecessary when MHs are smaller than 400 μm but may be highly recommended for MHs larger than 400 μm. Further RCTs with large sample sizes are warranted to validate these findings in future.

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Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials

10.21203/rs.2.9131/v2 ◽

2019 ◽

Author(s):

Ting Ye ◽

Ji-guo Yu ◽

Lin Liao ◽

Lan Liu ◽

Ting Xia ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Macular Hole ◽

Meta Analysis ◽

Cochrane Review ◽

Internal Limiting Membrane ◽

The Elderly ◽

Cochrane Library ◽

Controlled Trials ◽

Closure Rate ◽

Randomized Controlled

Abstract Background: After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomfortable and inconvenient for the elderly and those with medical comorbidities; it may also lead to certain postoperative complications. Hence, this study aimed to evaluate and compare the effect of postoperative FDP and non-face-down position (nFDP) on the closure rate of MHs following MH surgery. Methods: Randomized controlled trials (RCTs) were selected through an electronic search of the Cochrane Library, Pubmed, and Embase databases. Trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary measures included overall MH closure rate and subgroup analysis based on MH size. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Statistical analysis was performed using RevMan 5.0 software and Stata software 15.0. Results: Five RCTs composed of a total of 183 eyes in the FDP group and 175 eyes in the nFDP group were included in this meta-analysis. Statistical meta-analysis revealed that the overall MH closure rate in the FDP group was significantly higher than that in the nFDP group (OR = 2.27, 95% CI: 1.02 to 5.05, P = 0.04). For MH sizes smaller than 400 µm, the subgroup meta-analysis indicated that the closure rate of the FDP group was not significantly higher than that of the nFDP group (OR = 1.32, 95% CI: 0.39 to 4.49, P = 0.66). However, when MH size was larger than 400 µm, there was a significantly higher closure rate in the FDP group (OR = 2.95, 95% CI: 1.10 to 7.94, P = 0.03). Conclusions: Our results provide evidence that a face-down postoperative position seems to be unnecessary when MHs are smaller than 400 µm but may be highly recommended for MHs larger than 400 µm. Further RCTs with large sample sizes are warranted to validate these findings in future.

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Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

10.21203/rs.2.14564/v3 ◽

2019 ◽

Author(s):

Yu Shen ◽

Xiaoqin Lin ◽

Luyi Zhang ◽

Miaoqin Wu

Keyword(s):

Sensitivity Analysis ◽

Meta Analysis ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Visual Outcomes ◽

Flap Technique ◽

Macular Holes

Abstract 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. Keywords: Inverted internal limiting membrane flap technique, Internal limiting membrane peeling, Large macular hole, Meta-analysis

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Macular hole surgery recovery with and without face-down posturing: a meta-analysis of randomized controlled trials

10.21203/rs.2.9131/v1 ◽

2019 ◽

Author(s):

Ting Ye ◽

Ji-guo Yu ◽

Lin Liao ◽

Lan Liu ◽

Ting Xia ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Macular Hole ◽

Meta Analysis ◽

Cochrane Review ◽

Internal Limiting Membrane ◽

Cochrane Library ◽

Controlled Trials ◽

Macular Hole Surgery ◽

Closure Rate ◽

Randomized Controlled

Abstract Background After pars plana vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade, patients are often required to remain in a face-down position (FDP) to allow the gas bubble to push against the macular hole (MH) to promote hole closure. However, this position may be uncomfortable and inconvenient for the elderly and those with medical comorbidities; it may also lead to certain postoperative complications. Hence, this study aimed to evaluate and compare the effect of postoperative FDP and non-face-down position (nFDP) on the closure rate of MHs following macular hole surgery. Methods Randomized controlled trials (RCTs) were selected through an electronic search of the Cochrane library, Pubmed, and Embase databases. Trial eligibility and risk of bias were assessed according to Cochrane review methods. The primary measures included overall MH closure rate and subgroup analysis based on MH size. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Statistical analysis was performed using RevMan 5.0 software and Stata software 15.0. Results Five RCTs were included in this meta-analysis. These contained a total of 183 eyes in the FDP group and 175 in the nFDP group. Statistical meta-analysis revealed that the overall MH closure rate in the FDP group was significantly higher than that in the nFDP group (OR = 2.27, 95% CI: 1.02 to 5.05, P = 0.04). For MH size smaller than 400 µm, the subgroup meta-analysis indicated that the closure rate of the FDP group was not significantly higher than that of the nFDP group (OR = 1.32, 95% CI: 0.39 to 4.49, P = 0.66). However, when MH size was larger than 400 µm, there was a significantly higher closure rate in the FDP group (OR = 2.95, 95% CI: 1.10 to 7.94, P = 0.03). Conclusions Our results provide evidence that a face-down postoperative position seems to be unnecessary when MHs are smaller than 400 µm. For MHs larger than 400 µm, meta-analysis results demonstrated that an FDP might be highly recommended. Further RCTs with large numbers of samples are warranted to validate these findings in the future.

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Comparative efficacy evaluation of inverted internal limiting membrane flap technique and internal limiting membrane peeling in large macular holes: a systematic review and meta-analysis

10.21203/rs.2.14564/v1 ◽

2019 ◽

Author(s):

Yu Shen ◽

Xiaoqin Lin ◽

Luyi Zhang ◽

Miaoqin Wu

Keyword(s):

Sensitivity Analysis ◽

Meta Analysis ◽

Internal Limiting Membrane ◽

Ilm Peeling ◽

Internal Limiting Membrane Peeling ◽

Membrane Peeling ◽

Visual Outcomes ◽

Flap Technique ◽

Macular Holes

Abstract 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. Keywords: Inverted internal limiting membrane flap technique, Internal limiting membrane peeling, Large macular hole, Meta-analysis

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Conservative oxygen therapy for critically ill patients: a meta-analysis of randomized controlled trials

Journal of Intensive Care ◽

10.1186/s40560-021-00563-7 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Xiao-Li Chen ◽

Bei-Lei Zhang ◽

Chang Meng ◽

Hui-Bin Huang ◽

Bin Du

Keyword(s):

Sensitivity Analysis ◽

Randomized Controlled Trials ◽

Critically Ill Patients ◽

Oxygen Therapy ◽

Primary Outcome ◽

Meta Analysis ◽

Controlled Trials ◽

Icu Patients ◽

Randomized Controlled

Abstract Objective Conservative oxygen strategy is recommended in acute illness while its benefit in ICU patients remains controversial. Therefore, we sought to conduct a systematic review and meta-analysis to examine such oxygen strategies’ effect and safety in ICU patients. Methods We searched PubMed, Embase, and the Cochrane database from inception to Feb 15, 2021. Randomized controlled trials (RCTs) that compared a conservative oxygen strategy to a conventional strategy in critically ill patients were included. Results were expressed as mean difference (MD) and risk ratio (RR) with a 95% confidence interval (CI). The primary outcome was the longest follow-up mortality. Heterogeneity, sensitivity analysis, and publication bias were also investigated to test the robustness of the primary outcome. Results We included seven trials with a total of 5265 patients. In general, the conventional group had significantly higher SpO2 or PaO2 than that in the conservative group. No statistically significant differences were found in the longest follow-up mortality (RR, 1.03; 95% CI, 0.97–1.10; I2=18%; P=0.34) between the two oxygen strategies when pooling studies enrolling subjects with various degrees of hypoxemia. Further sensitivity analysis showed that ICU patients with mild-to-moderate hypoxemia (PaO2/FiO2 >100 mmHg) had significantly lower mortality (RR, 1.24; 95% CI, 1.05–1.46; I2=0%; P=0.01) when receiving conservative oxygen therapy. These findings were also confirmed in other study periods. Additional, secondary outcomes of the duration of mechanical ventilation, the length of stay in the ICU and hospital, change in sequential organ failure assessment score, and adverse events were comparable between the two strategies. Conclusions Our findings indicate that conservative oxygen therapy strategy did not improve the prognosis of the overall ICU patients. The subgroup of ICU patients with mild to moderate hypoxemia might obtain prognosis benefit from such a strategy without affecting other critical clinical results.

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