Postoperative Epiretinal Membrane After Fovea-sparing Versus Standard Internal Limiting Membrane Peeling for Myopic...

To compare the incidence and outcomes of postoperative epiretinal membrane (ERM) formation after fovea-sparing internal limiting membrane peeling (FSIP) and standard internal limiting membrane (ILM) peeling in eyes with myopic traction maculopathy (MTM).

Multicenter, retrospective clinical cohort study (Schisis report no. 4).

Patients with MTM who underwent pars plana vitrectomy (PPV) at 10 institutions between June 2008 and July 2024, with at least 12 months of follow-up, were included. Postoperative ERM was identified on optical coherence tomography (OCT) and graded using the Govetto classification. The main outcomes were the 12-month incidence of postoperative ERM and postoperative visual outcomes.

We included a total of 206 eyes (201 patients); 46 eyes treated with FSIP and 160 eyes treated with standard ILM peeling. Of the 206 eyes, postoperative ERM developed in 16 eyes (7.8%) at 12 months: 8 eyes (17.4%) in the FSIP group and 8 eyes (5.0%) in the standard ILM peeling group. The incidence of postoperative ERM was significantly higher in the FSIP group than in the standard ILM peeling group (P = .014), and univariable logistic regression analysis revealed that FSIP was significantly associated with postoperative ERM at 12 months (OR = 4.00, 95% CI = 1.39-11.55, P = .009). Of the 8 eyes with postoperative ERM after FSIP, 6 eyes showed stage 1 ERM and 2 eyes showed stage 2 ERM. Of the 8 eyes with postoperative ERM after standard ILM peeling, 7 eyes showed stage 1 ERM and 1 eye showed stage 2 ERM. No additional surgery was required for postoperative ERM during 12 months. Postoperative logarithm of minimum angle of resolution visual acuity at 12 months did not differ significantly between eyes with (0.50 ± 0.43) and without ERM (0.42 ± 0.52; P = .517). The incidence of postoperative macular hole (MH) was lower in the FSIP group (2.2%) than in the standard ILM peeling group (12.8%), although the difference was not statistically significant (P = .071).

FSIP increased the incidence of postoperative ERM compared with standard ILM peeling, but most ERMs were subclinical and did not affect vision. Despite the elevated ERM risk, the potential benefit of FSIP in reducing postoperative macular hole formation may outweigh its drawbacks.