Idiopathic epiretinal membrane and when to operate

Abstract

Idiopathic epiretinal membrane is a product of pathological processes during the progression of posterior vitreous detachment. Its incidence increases over time and reaches up to 34% of the population over 60 years of age, a rate that significantly increased after the introduction of spectral‐domain optical coherence tomography (SD‐OCT) in daily clinical practice.Traditionally, the decision to intervene was mostly based on the balance between subjective patient complaints and the risks related to vitrectomy surgery itself and less on OCT imaging, especially since advanced epiretinal membranes as seen on OCT are often accompanied by remarkably good visual acuity. Additionally, unilateral incidence, could mask symptoms, depending on eye dominance. However, more recently, technological advances in posterior segment surgery, have significantly reduced the rate of post vitrectomy complications, leading to earlier surgical intervention practices.There is great literature debate concerning the determination of the right intervention timing for idiopathic epiretinal membrane. The most important predictive factors include preoperative visual acuity, the presence of metamorphopsia and impact on the quality of life.According to existing literature, natural progression of the disease leads to anatomical deterioration in a rate ranging from 17 to 39%. Factors related to faster deterioration include metamorphopsia and the presence of cystic formations in the inner layers of the retina on SD‐OCT.