Abstract
PURPOSE: To evaluate sparing or embedding technique for lamellar hole-associated epiretinal proliferation and in comparison with traditional internal limiting membrane and epiretinal membrane peeling in lamellar macular holes. METHODS: PubMed, Web of Science, Medline, EMBASE, Cochrane, CNKI, Wan Fang, and VIP Databases (PROSPERO number CRD42024466392) were searched. Trials of various lamellar hole-associated epiretinal proliferation removal or preservation techniques in lamellar macular holes were included (case reports of only 1 case excluded). Postoperative changes in best-corrected visual acuity were calculated. Central retinal thickness and number of patients with new postoperative intact ellipsoid zones were secondary outcomes. RESULTS: Eight studies were eligible and four compared with peeling groups. Preservation groups showed a significant visual improvement operatively (mean difference = -0.25 logMAR; 95% confidence interval = -0.30 to -0.21; P < 0.00001) and improved compared with peeling groups (mean difference = -0.19 logMAR; 95% confidence interval = -0.29 to -0.1; P < 0.0001). In addition, the number of patients with intact ellipsoid zones increased in the preserving groups (odd ratio = 2.55; 95% confidence interval = 1.48-4.38; P = 0.0007) and also increased compared with peeling groups (odd ratio =10.80; 95% confidence interval = 1.86-62.83; P = 0.008). CONCLUSION: Based on the current evidence, lamellar hole-associated epiretinal proliferation sparing or embedding technique has favorable postoperative outcomes compared with peeling technique for lamellar macular holes.