Approach and surgical management of epiretinal membrane

Epiretinal membrane (ERM) surgery has undergone significant investigation over the last 2 years including assessment of novel surgical techniques and regarding the necessity of internal limiting membrane (ILM) peeling. This review seeks to highlight the latest literature in regards to ERM surgery from unique ERM profiles to clinical trials of surgical approach.

The summative literature highlight that peeling of ILM may reduce recurrence compared to solely peeling ERM; however, these recurrences tend to be mild and nonvisually significant. Optical coherence tomography (OCT) has been leveraged preoperatively, intra-operatively, and postoperatively to enrich knowledge regarding risk factors for worse visual outcomes and deep learning models that are able to predict the anatomic outcome of ERM surgery after review of the preoperative OCT. There is no significant difference in outcomes between sequential and concurrent ERM surgery with cataract surgery. In uveitis evaluations related to ERM, posterior and intermediate uveitis were most associated with ERM, while in pediatric ERM, extent of diffuseness of central ERM correlated with surgical visual improvements.

The latest ERM research has richly expanded the literature, allowing surgeons to better predict visual improvements postoperatively. This includes using OCT imaging biomarkers, but there remains a litany of unresolved questions about best surgical practices that are actively undergoing assessment.