Intraocular tamponade choice with vitrectomy and ILM peeling for idiopathic macular hole; a systematic review and meta-analysis
Abstract
TOPIC
A variety of different tamponade agents are used with vitrectomy combined with internal limiting membrane (ILM) peeling for the treatment of idiopathic macular holes. These include air, gas (SF6, C2F6, C3F8) and silicone oil. The optimum tamponade agent is uncertain and we aimed to review the effect of tamponade choice on hole closure and the visual outcome.
CLINICAL RELEVANCE
While most surgeons initially chose to use long-acting gas (C3F8), there has been a gradual change in practice to increasing use of medium (C2F6) and short-acting gases (SF6) or even air. However, there is no consensus regarding their relative efficacy.
METHODS
Systematic review and metanalysis of randomised control trials (RCT), prospective and retrospective comparative cohort studies comparing different tamponade agents in patients undergoing vitrectomy and internal limiting membrane peeling for primary idiopathic macular holes. For RCTs, the risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs, while for non-randomized studies the Risk Of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool was used.
RESULTS
Thirteen publications, including two RCTs were identified. Overall, there was no significant difference in anatomical closure rates between studies using SF6 compared to either C3F8 or C2F6 [OR=0.74, 95% CI = (0.51, 1.08)]. A subgroup analysis showed a significantly higher closure using SF6 [OR=0.49, 95% CI = (0.30, 0.79)] in patients without postoperative…
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