WITH OR WITHOUT INTERNAL LIMITING MEMBRANE PEELING FOR IDIOPATHIC EPIRETINAL MEMBRANE A Meta-Analysis of Randomized Controlled Trials

Purpose: To clarify whether internal limiting membrane (ILM) peeling provides better outcomes for patients with idiopathic epiretinal membrane. Methods: Randomized controlled trials comparing epiretinal membrane removal with and without ILM peeling were searched in Embase, PubMed, Web of Science, Cochrane Library, and CNKI before April 15, 2020. The pooled mean difference (MD) for best-corrected visual acuity, central macular thickness, and odds ratio for recurrence were calculated. Results: Eight randomized controlled trials involving 422 eyes were included. No significant difference in best-corrected visual acuity (final follow-up: MD, 0.03 logarithm of the minimum angle of resolution [1.5 Early Treatment Diabetic Retinopathy Study letters]; 95% confidence interval [CI], -0.04 to 0.09 [-4.5 to 2 Early Treatment Diabetic Retinopathy Study letters]; P = 0.40) or recurrence rate (odds ratio, 0.21; 95% CI, 0.04-1.05; P = 0.06) between the groups was observed. However, patients with ILM peeling presented thicker central macular thickness at 3 months (MD, 16.36; 95% CI, 1.26-31.46; P = 0.03), 6 months (MD, 22.64; 95% CI, 10.29-34.98; P = 0.0003) and the final follow-up (MD, 25.87; 95% CI, 13.96-37.79; P < 0.0001). Conclusion: The study showed that ILM peeling did not significantly improve the postoperative visual outcome or decrease recurrence, but result in thicker central macular thickness, indicating that it is inessential for idiopathic epiretinal membrane.