Fovea-sparing as opposed to total peeling of internal limiting membrane for myopic foveoschisis: A systematic review and meta-analysis.

ABSTRACT Topic The effectiveness of fovea-sparing (FS) peeling of internal limiting membrane (ILM) to treat myopic foveoschisis (MF) has not been fully understood. The present meta-analysis aimed to compare postoperative visual and anatomical outcomes between FS peeling and total peeling (TP) of ILM in pars plana vitrectomy for the treatment of MF. Clinical Relevance Postoperative macular hole (MH) development is not uncommon and a serious complication after surgery for MF, with poor visual prognosis. FS peeling of ILM is expected to reduce the risk of postoperative MH, however, there has been no statistically significant evidence to prove this hypothesis. In addition, its effect on postoperative visual acuity has not been clear. Methods MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE were systematically reviewed, and studies that compared FS with total ILM peeling in MF surgery were retrieved. The protocol was registered in International Prospective Register of Systematic Reviews (PROSPERO, CRD42020201675). Primary outcome measures were the postoperative best-corrected visual acuity (BCVA) and frequency of postoperative MH development. Certainty of evidence was evaluated by Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results Eight studies with 300 eyes in 289 patients were included. All studies were non-randomized and observational. The postoperative BCVA was significantly better in eyes treated with FS (MD, -0.15 logMAR; 95%CI, -0.24 to -0.05; P=0.002). The risk of postoperative MH was significantly lower in the FS group (odds ratio [OR], 0.19; 95% CI, 0.06 to 0.56; P=0.003). There was no significant difference in postoperative central foveal thickness (MD, 6.22 μm; 95%CI, -14.2to 26.7; P=0.94). The certainty of evidence regarding lower frequency of postoperative MH after FS peeling was considered moderate, while the certainty regarding better postoperative BCVA after FS peeling was judged as low. Conclusion FS may contribute to better visual acuity outcome and lower risk of postoperative MH development in eyes with MF.