[Which epiretinal membranes should be operated?]

Abstract

Epimacular membrane (ERM) formation is an age-dependent more or less vision-threatening finding. Increased life expectancy and patient demand for better vision have led to increasing numbers of patients seeking therapy, making selection for surgery mandatory. The impressive improvements in macular hole surgery have influenced the epiretinal membrane and have renewed its therapeutic approach. Disturbing metamorphopsia, visual deterioration under 5/10, especially near-vision alteration and binocular disturbance, are major symptoms to motivate surgery. As epiretinal membrane removal can be considered a relatively safe and effective procedure today, with ILM peeling and simultaneous cataract surgery, visual acuity alone is no longer the single criterion. The patient's demands regarding vision in daily life should be taken into account. Patients with moderate visual loss, recent onset of symptoms, or progression are the best candidates for ERM surgery. Functional outcome in patients with poor initial visual acuity or long-standing disease is unsatisfactory. The OCT macular profile helps detect the best candidates with thickening between 300 and 450 microns. The presence of a pseudo hole, traction, or an intraretinal cyst does not impair functional results. Complete traction relief during pucker surgery is believed to be a precondition for good functional results. Intended ILM peeling is a tool to achieve this goal.