Vitrectomy Versus Observation for Lamellar Macular Holes With Epiretinal Proliferation: A Systematic Review and Meta-Analysis.

Abstract

To compare the visual and anatomical outcomes of vitrectomy with those of observation in eyes with lamellar macular holes associated with epiretinal proliferation (LHEP). LHEP is increasingly recognized in clinical practice, yet uncertainty persists regarding the visual benefits and full-thickness macular hole (FTMH) progression risk of surgical versus observational management. Reliable outcome estimates are essential for patient counseling and treatment planning. A systematic review and meta-analysis. Literature search of PubMed, Embase, Scopus, Cochrane Library, and Web of Science were performed according to PRISMA guidelines and registered prospectively on PROSPERO (CRD420251089664). Eligible studies included adult patients with lamellar macular holes and LHEP managed with either vitrectomy or observation. The primary outcome was the change in best-corrected visual acuity (BCVA, logMAR). The secondary outcomes included progression to FTMH. Random-effects meta-analyses were conducted separately for surgical and observational cohorts due to limited direct comparative data. The risk of bias was assessed via the Newcastle-Ottawa Scale and the RoB 2 tool. Publication bias was evaluated via funnel plots, Egger's test, and trim-and-fill analysis. Seventeen studies encompassing 610 eyes met the inclusion criteria. In surgically treated eyes (14 studies; 328 eyes), vitrectomy was associated with significant visual improvement (pooled mean difference in BCVA -0.170 logMAR; 95% CI [-0.254, -0.086]; P < .001), with minimal heterogeneity (I² = 0%). In the observational cohort (5 studies; 282 eyes), no significant change in visual acuity was observed (-0.029 logMAR; 95% CI [-0.118, 0.176]; P = .695). The pooled rate of progression to FTMH was 7.5% (95% CI [4.0%,13.6%]) after vitrectomy and 4.2% (95% CI [1.4%, 11.8%]) after observation, with overlapping confidence intervals. Bias-adjusted analyses suggested a wider confidence interval for FTMH progression in the vitrectomy cohort, 12.4% (95% CI [7.4%, 20.1%]), and observational cohort, 10.1% (95% CI [3.3%, 27.2%]). In eyes with LHEP, vitrectomy is associated with clinically meaningful visual acuity improvement, whereas no significant change was observed in pooled observational data, without a clear increase in progression to FTMH. These findings support consideration of surgical intervention in appropriately selected patients, guided by symptoms and OCT-based features.