Comparison of inverted inner limiting membrane flap technique and traditional peeling for visual recovery and microscopic structural improvement in patients with macular holes: a meta-analysis

Background A meta-analysis comparing the efficacy of internal limiting membrane (ILM) peeling and inverted ILM flap techniques for the treatment of macular holes (MH). Methods Researchers searched the Cochrane Library and PubMed database for relevant randomized controlled trials published from the establishment of the database to June 30, 2025. The control and intervention groups were the ILM peeling group and the inverted ILM flap group, respectively. Literature quality assessment was conducted using the Cochrane Risk of Bias Assessment Tool. Meta-analysis was performed using Review Manager and Stata software. Anatomical closure rate and best-corrected visual acuity (BCVA) were used as primary outcomes. External limiting membrane (ELM) and ellipsoid zone (EZ) were used as secondary outcomes. Results A total of 202 relevant literature articles were screened, and 10 studies were ultimately included. Compared with the traditional ILM peeling group (ILM peeling), the closure rate was significantly higher in the inverted inner limiting membrane flap group (InFlap). In the ≥ 600 μm subgroup, the closure rate was significantly higher with InFlap. there was no statistically significant difference in closure rates between ILM peeling and InFlap in terms of mean BCVA. And also, ILM peeling was higher than InFlap in either the <600 μm subgroup or the ≥ 600 μm subgroup. the EZ was significantly higher in the ILM peeling compared to the InFlap. Conclusions For MHs with a diameter greater than 600 µm, the inverted ILM flap technique can significantly improve anatomical closure rates. Trial registration Registration number: CRD420251139305. This study was registered at PROSPERO and no modifications were made.