Comparison between Fovea-Sparing and Complete Internal Limiting Membrane Peeling for the Treatment of Myopic Traction Maculopathy: A Systemic Review and Meta-Analysis

Abstract

<b><i>Introduction:</i></b> Myopic traction maculopathy (MTM) is a major cause of impaired vision in eyes with high myopia, which is characterized by retinal thickening, retinoschisis, lamellar macular hole (MH), and foveal retinal detachment. Pars plana vitrectomy (PPV) with fovea-sparing internal limiting membrane peeling (ILMP) has been developed to theoretically prevent postoperative MH formation and improve best-corrected visual acuity (BCVA) gain for MTM compared with the complete ILMP. However, in previous studies, the anatomic and visual outcomes still remain uncertain and controversial. <b><i>Objectives:</i></b> The aim of this study was to evaluate the anatomic and visual outcomes of vitrectomy with fovea-sparing ILMP for the treatment of MTM compared with complete ILMP. <b><i>Methods:</i></b> Articles from PubMed, EMBASE, Web of Science, and Cochrane Library were systematically retrieved. The main outcomes were the rate of a postoperative MH and visual improvement of BCVA (converted to logarithm of the minimum angle of resolution [logMAR]). The secondary outcomes were the proportion of patients with visual improvement, the proportion of anatomic success, preoperative and postoperative BCVA, preoperative and postoperative central fovea thickness, and time to anatomic resolution. <b><i>Results:</i></b> There was a higher rate of postoperative MH formation (odds ratio [OR] 5.64; 95% confidence interval [CI]: 1.72–18.44; <i>p</i> = 0.004) and less improvement of BCVA in logMAR (mean difference [MD] −0.09; 95% CI: −0.18 to 0.00; <i>p</i> = 0.04) in the complete ILMP group. However, postoperative BCVA (MD 0.14; 95% CI: 0.00–0.27; <i>p</i> = 0.05), the proportion of patients with visual improvement (OR 0.39; 95% CI: 0.15–1.02; <i>p</i> = 0.05), postoperative central foveal thickness (MD −10.02; 95% CI: −24.4 to 4.36; <i>p</i> = 0.17), the rate of anatomic success (MD 0.39; 95% CI: 0.15–1.03; <i>p</i> = 0.06), and time to resolution (MD −1.65; 95% CI: −3.66 to 0.36; <i>p</i> = 0.11) showed no significant differences. <b><i>Conclusion:</i></b> PPV combined with the fovea-sparing ILMP could contribute to a lower MH formation rate and more improvement of BCVA in logMAR than PPV combined with complete ILMP.