Supplementary Material for: Inverted Internal Limiting Membrane Flap VS. ILM Peeling for＜400μm Macular Hole: a meta-analysis and systematic review

Purpose: The inverted internal limiting membrane (ILM) flap technique was initially developed for the closure of large macular holes (MH). However, its efficacy in treating small holes has been a matter of debate. This study aimed to compare the anatomical and visual outcomes of vitrectomy (PPV) combined with the inverted ILM flap and ILM peeling in cases of small and medium-sized MHs. Methods: A meta-analysis was conducted by searching the relevant literature in databases, including PubMed, Web of Science, Embase, and Cochrane Library. The search included articles published from the inception of the databases up until January 2023. The inclusion criteria limited the studies to only experimental based research. The heterogeneity, publication bias, and sensitivity analysis were performed to ensure the statistical power and reliability of the analysis. Results: Five studies, including two RCTs and three non-randomized concurrent control trials (n-RCTs), comprising a total of 269 eyes, were analyzed. The results showed no significant difference in the MH closure rate between the two group (odds ratio (OR) = 0.29, 95% confidence interval (CI): 0.04-1.96, P = 0.33). Furthermore, there were no significant differences observed in visual acuity, external limiting membrane (ELM) and ellipsoid zone (EZ) integrity at 3 months (ELM OR = 0.88, EZ OR = 0.85) or 12 months (ELM OR = 0.96, EZ OR = 1.39) post-operation between the two groups. Conclusion: The surgical repair of MHs smaller than 400μm with ILM flap seem to be similar in VA improvement and anatomical recovery compared to the traditional technique.

研究背景与目的：内界膜（internal limiting membrane, ILM）翻转瓣技术最初专为闭合大型黄斑裂孔（macular hole, MH）研发，但其治疗小型黄斑裂孔的有效性一直存在争议。本研究旨在比较玻璃体切除术（pars plana vitrectomy, PPV）联合ILM翻转瓣与ILM剥除术治疗中小型MH的解剖学结局与视觉功能结局。

研究方法：本研究通过检索PubMed、Web of Science、Embase及Cochrane Library等数据库的相关文献开展荟萃分析，检索时限为各数据库建库至2023年1月。纳入标准限定仅纳入实验性研究。本研究进行了异质性检验、发表偏倚分析及敏感性分析，以确保分析的统计效力与可靠性。

研究结果：最终纳入5项研究进行分析，包括2项随机对照试验（randomized controlled trial, RCT）与3项非随机同期对照试验（non-randomized concurrent control trial, n-RCT），共计269只患眼。结果显示，两组MH闭合率无显著差异（优势比（odds ratio, OR）=0.29，95%置信区间（confidence interval, CI）：0.04~1.96，P=0.33）。此外，术后3个月及12个月时，两组在视力（visual acuity, VA）、外界膜（external limiting membrane, ELM）及椭圆锥体区（ellipsoid zone, EZ）完整性方面均无显著差异（术后3个月：ELM OR=0.88，EZ OR=0.85；术后12个月：ELM OR=0.96，EZ OR=1.39）。

研究结论：与传统手术方式相比，采用ILM翻转瓣技术修复直径小于400μm的MH，在视力改善与解剖结构恢复方面效果相近。