Comparing membrane peeling techniques in lamellar macular hole surgery: A systematic review and meta‐analysis

Aims: To compare outcomes of standard and alternative membrane peeling techniques in LMH surgery. Methods: A systematic review and meta‐analysis was performed per the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Pairwise meta‐analysis of mean change in best corrected visual acuity (BCVA as logMAR) and LMH closure rate between flap embedding (FE) and standard peeling (ST) were conducted. A proportional meta‐analysis evaluated FTMH prevalence for each technique. Results: 36 studies of 1200 eyes were included. Three techniques were identified: ST (29 studies), FE (7 studies) and fovea‐sparing peeling (4 studies). FE was superior to ST in BCVA change (MD ‐0.21; CI ‐0.33 to ‐0.10), LMH closure (RR 1.53; CI 1.23–1.90) and postoperative FTMH (RR 0.08; CI 0.01 to 0.58). LMH closure rate was higher (0.97; CI 0.88 to 0.99 vs. 0.81; CI 0.70 to 0.88) in alternative vs. ST, with postoperative FTMH occurring only in ST peelings (0.026; CI 0.013‐0.054). Conclusions: Alternative peeling techniques have superior outcomes. Further randomized controlled studies are needed to confirm their efficacy and innocuity.