Macular Epiretinal Membrane Surgery

Macular epiretinal membrane (ERM) is a common eye disease in which cellular proliferation and metaplasia lead to the formation of avascular fibrocellular tissue on the inner retinal surface. ERM formation has been associated with and can result from a variety of primary intraocular diseases, including retinal vascular disease, vitreoretinal inflammatory conditions, postoperative and posttraumatic states, congenital posterior segment anomalies, intraocular tumors, and retinal breaks and detachment. However, the vast majority of ERMs are considered to be idiopathic and are not associated with other systemic or ocular diseases. Most commonly, ERMs are asymptomatic or cause mild metamorphopsia and/or modest decreased visual acuity. A minority of ERMs can cause sufficient macular distortion and macular edema to induce clinicians to recommend surgical ERM removal. The aim of surgical intervention for ERM is to improve traction-induced visual disturbance. This is achieved by removing the ERM in order to relieve macular traction. During the more than 40 years since the first report that surgical ERM removal is effective for improving visual function, progress in optical coherence tomography technology and vitrectomy systems has resulted in detailed elucidation of ERM pathology and has enabled less invasive treatment. However, clear criteria indicating surgery have still not been established, and surgery indication is therefore still based on the patient's subjective symptoms along with the physician's judgment. Another problem is that not all patients show satisfactory recovery of visual function after surgery. Further research is thus needed on the criteria for indicating ERM surgery and the factors associated with visual function prognosis.