Pub Date : 2026-01-01DOI: 10.1016/j.oret.2025.05.003
Zhenlong Ran MD , Jiayue Wang MD , Dongyan Pan MD
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<div><h3>Topic</h3><div>To compare the outcomes of the standard (ST), flap embedding (FE), and fovea-sparing (FS) peeling techniques in lamellar macular hole (LMH) surgery.</div></div><div><h3>Clinical Relevance</h3><div>Lamellar macular hole surgery involves pars plana vitrectomy with epiretinal membrane or proliferation and internal limiting membrane peeling. Flap embedding and FS aim to improve outcomes and reduce complications, but no systematic review has yet compared ST, FE, and FS for LMH treatment.</div></div><div><h3>Methods</h3><div>This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on PROSPERO (CRD42024547022). MEDLINE and Embase databases were queried from inception to January 2025. Pairwise meta-analysis (MA) compared mean differences (MD) in best-corrected visual acuity (BCVA), LMH closure, and postoperative full-thickness macular hole (FTMH) rates between ST and FE; no comparative studies including FS were found. Meta-analysis of prevalence and means respectively assessed the prevalence of inner segment/outer segment (IS/OS) defects and the mean change in central foveal thickness (CFT) for each peeling technique. Outcomes were evaluated at 1, 3, 6, and 12 months when reported and at final follow-up (FU) for all studies.</div></div><div><h3>Results</h3><div>Three peeling techniques were identified: ST (29 studies, 886 eyes), FS (3 studies, 64 eyes), and FE (8 studies, 196 eyes). In pairwise MA, FE was superior to ST in improving BCVA (n = 3 studies; MD −0.20; 95% confidence interval [CI]: −0.31 to −0.09 logarithm of the minimum angle of resolution; I<sup>2</sup> = 0%; low certainty), LMH closure rate (n = 3 studies; risk ratios [RRs] 1.53; 95% CI: 1.23 to 1.90; I<sup>2</sup> = 0%; low certainty), and postoperative FTMH rate (n = 2 studies; RR 0.08; 95% CI: 0.01 to 0.58; I<sup>2</sup> = 0%; low certainty) at final FU. The pooled mean change in CFT at final FU was 52.55 [95% CI: −10.57 to 115.67] μm (n = 4 studies; I<sup>2</sup> = 93.1%; very low certainty) for the ST group, 83.12 [95% CI: 44.91 to 121.33] μm (n = 5 studies; I<sup>2</sup> = 88.5%; very low certainty) for the FE group, and 102.28 [95% CI: −236.56 to 441.12] μm (n = 2 studies; I<sup>2</sup> = 85.7%; very low certainty) for the FS group (<em>P</em> = 0.2709). Preoperative IS/OS defect prevalence in the “true” LMH subgroup showed no significant difference among techniques (<em>P</em> = 0.2242), but final FU prevalence differed significantly between ST, FS, and FE (<em>P</em> = 0.0005).</div></div><div><h3>Conclusion</h3><div>Flap embedding demonstrated superiority in BCVA improvement, LMH closure, and postoperative FTMH rates in pairwise MA; IS/OS postoperative defect proportion was higher in ST studies, but the paucity of comparative studies and very low to low certainty of evidence preclude definitive conclusions.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or
{"title":"Comparing Membrane Peeling Techniques in Lamellar Macular Hole Surgery","authors":"Yosra Er-reguyeg MD, MSc (C) , Elyazid Rhalem MD (C) , Eunice Linh You MD, MSc , Anas Abu-Dieh MD , Mélanie Hébert MD, MSc , Huixin Zhang MD , Serge Bourgault MD , Mathieu Caissie MD , Éric Tourville MD , Ali Dirani MD, MSc","doi":"10.1016/j.oret.2025.06.004","DOIUrl":"10.1016/j.oret.2025.06.004","url":null,"abstract":"<div><h3>Topic</h3><div>To compare the outcomes of the standard (ST), flap embedding (FE), and fovea-sparing (FS) peeling techniques in lamellar macular hole (LMH) surgery.</div></div><div><h3>Clinical Relevance</h3><div>Lamellar macular hole surgery involves pars plana vitrectomy with epiretinal membrane or proliferation and internal limiting membrane peeling. Flap embedding and FS aim to improve outcomes and reduce complications, but no systematic review has yet compared ST, FE, and FS for LMH treatment.</div></div><div><h3>Methods</h3><div>This study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and registered on PROSPERO (CRD42024547022). MEDLINE and Embase databases were queried from inception to January 2025. Pairwise meta-analysis (MA) compared mean differences (MD) in best-corrected visual acuity (BCVA), LMH closure, and postoperative full-thickness macular hole (FTMH) rates between ST and FE; no comparative studies including FS were found. Meta-analysis of prevalence and means respectively assessed the prevalence of inner segment/outer segment (IS/OS) defects and the mean change in central foveal thickness (CFT) for each peeling technique. Outcomes were evaluated at 1, 3, 6, and 12 months when reported and at final follow-up (FU) for all studies.</div></div><div><h3>Results</h3><div>Three peeling techniques were identified: ST (29 studies, 886 eyes), FS (3 studies, 64 eyes), and FE (8 studies, 196 eyes). In pairwise MA, FE was superior to ST in improving BCVA (n = 3 studies; MD −0.20; 95% confidence interval [CI]: −0.31 to −0.09 logarithm of the minimum angle of resolution; I<sup>2</sup> = 0%; low certainty), LMH closure rate (n = 3 studies; risk ratios [RRs] 1.53; 95% CI: 1.23 to 1.90; I<sup>2</sup> = 0%; low certainty), and postoperative FTMH rate (n = 2 studies; RR 0.08; 95% CI: 0.01 to 0.58; I<sup>2</sup> = 0%; low certainty) at final FU. The pooled mean change in CFT at final FU was 52.55 [95% CI: −10.57 to 115.67] μm (n = 4 studies; I<sup>2</sup> = 93.1%; very low certainty) for the ST group, 83.12 [95% CI: 44.91 to 121.33] μm (n = 5 studies; I<sup>2</sup> = 88.5%; very low certainty) for the FE group, and 102.28 [95% CI: −236.56 to 441.12] μm (n = 2 studies; I<sup>2</sup> = 85.7%; very low certainty) for the FS group (<em>P</em> = 0.2709). Preoperative IS/OS defect prevalence in the “true” LMH subgroup showed no significant difference among techniques (<em>P</em> = 0.2242), but final FU prevalence differed significantly between ST, FS, and FE (<em>P</em> = 0.0005).</div></div><div><h3>Conclusion</h3><div>Flap embedding demonstrated superiority in BCVA improvement, LMH closure, and postoperative FTMH rates in pairwise MA; IS/OS postoperative defect proportion was higher in ST studies, but the paucity of comparative studies and very low to low certainty of evidence preclude definitive conclusions.</div></div><div><h3>Financial Disclosure(s)</h3><div>Proprietary or ","PeriodicalId":19501,"journal":{"name":"Ophthalmology. Retina","volume":"10 1","pages":"Pages 39-60"},"PeriodicalIF":5.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01DOI: 10.1016/j.oret.2025.07.007
Alicia Chen MD , Ian Seddon DO , James Rhead BS , David J. Browning MD, PhD
Purpose
To examine near infrared reflectance (NIR) imaging in acute syphilitic outer retinitis.
Design
Retrospective case series.
Subjects
Patients diagnosed with ocular syphilis from 2015 to 2024 at Wake Forest Baptist Hospital.
Methods
Two authors independently graded NIR images for notable imaging characteristics with joint review with a third grader for disagreements.
Main Outcome Measures
Near infrared reflectance images were graded based on presence of white dot lesions, granular pattern (defined as a fine pattern of hyperreflective dots), geographic reflectivity changes (defined as an area of hyporeflectivity delineated by a demarcation line), and hyporeflectivity changes due to either subretinal fluid or pigment epithelial detachments.
Results
Thirty-nine eyes from 22 ocular syphilis patients with available NIR images were included in the study. The most common findings were white dots (79.5%), granular pattern (56.4%), and geographic reflectivity changes (38.5%). A new finding was a hyperreflective patch on NIR that correlated to a hyperreflective layer above the ellipsoid zone (EZ) on OCT. After penicillin therapy, this area of hyperreflectivity was replaced with white dots on NIR that correlated with new subretinal hyperreflective foci on OCT.
Conclusions
Near infrared reflectance imaging in ocular syphilis can highlight subtle retinal changes, including changes in the EZ layer and subretinal deposits. Understanding NIR findings in ocular syphilis can help make early diagnoses and monitor treatment responses.
Financial Disclosure(s)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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