Peeling versus Sparing Techniques for Epiretinal Proliferation in Lamellar Macular Hole Surgery: A Meta-analysis

Purpose: Lamellar macular hole (LMH) with epiretinal proliferation (ERP) is characterized by poor postoperative visual outcomes.However, differences in outcomes according to surgical technique remain unclear.In this meta-analysis, we compare visual outcomes between peeling and sparing ERP techniques in patients with LMH.Methods: We conducted a systematic search across the MEDLINE, EMBASE, and Cochrane databases from inception to September 2024 and retrieved 17 studies.Seven studies compared the peeling ERP technique to conventional LMH surgery, five compared the sparing ERP technique to conventional LMH surgery, and five studies compared the peeling ERP technique to the sparing ERP technique.Results: Patients with LMH and ERP (regardless of surgical technique) showed poorer postoperative best-corrected visual acuity (BCVA) improvement than those without ERP (p = 0.03).However, in subgroup analysis, the sparing ERP technique resulted in BCVA outcomes comparable to those of patients without ERP (p = 0.41), whereas the peeling technique led to significantly less improvement (p = 0.04).In addition, sparing ERP resulted in significantly greater BCVA than peeling ERP (p = 0.004).The restoration rate of the ellipsoid zone (EZ) defect was not associated with surgical technique (p = 0.19) or the presence of ERP (p = 0.67).Conclusions: In patients with LMH and ERP, sparing ERP leads to BCVA improvement, similar to patients without ERP.The EZ restoration rate is not significantly related to the choice of surgical technique or presence of ERP.