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Internal limiting membrane peeling or not: a systematic review and meta-analysis of idiopathic macular pucker surgery
  1. Xiao-Ling Fang1,
  2. Yao Tong2,
  3. Ya-Li Zhou3,
  4. Pei-Quan Zhao2,
  5. Zhao-Yang Wang3
  1. 1Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai, China
  2. 2Department of Ophthalmology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  3. 3Department of Ophthalmology, The Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  1. Correspondence to Dr Zhao-yang Wang, Department of Ophthalmology, The Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai 200011, P. R. China; zhaokekewzy{at}


Purpose To determine whether internal limiting membrane (ILM) peeling improves anatomical and functional outcomes in idiopathic macular pucker (IMP)/epiretinal membrane (ERM) surgery in this systematic review and meta-analysis.

Methods We searched the PubMed, Medline, Web of Science, Cochrane, Ovid MEDLINE, and CNKI databases for studies published before 15 September 2016. The eligibility criteria included studies comparing ILM peeling versus no-peeling for IMP surgery.

Results Thirteen articles (10 retrospective cohort studies, 1 prospective cohort study and 2 randomised controlled trials (RCTs)) were included in the review. Primary outcomes: no differences were observed in the best-corrected visual acuity (BCVA) or central macular thickness (CMT) at 12 months; however, lower ERM recurrence (OR, 0.13; 95% CI 0.04 to 0.41; p=0.0004) and reoperation rates (OR, 0.10; 95% CI 0.02 to 0.49; p=0.004) that favoured ILM peeling were observed at the final follow-up. Secondary outcomes: no difference was observed in BCVA at 3, 6 months, the final follow-up or in CMT at 3, 6 months, the final follow-up. Significantly increased CMT, which favoured ILM peeling, was observed at the final follow-up (p=0.002) in the RCTs.

Conclusions ILM peeling yielded greater anatomical success, but no improvement in functional outcomes as the treatment of choice for patients undergoing IMP surgery.

  • Treatment Surgery
  • Retina

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  • Contributors Z-YW contributed to the design, interpretation, surgery procedure and made revisions to the manuscript. X-LF contributed to experimental data acquisition and wrote the first draft. YT contributed to online registration and data acquisition. Y-LZ and P-QZ contributed to the data analysis.

  • Funding This work was supported by Project of the National Natural Science Funds of China (No. 81371040) and Shanghai Pujiang Program (No. 15PJD028).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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