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    This is the first study to evaluate long-term outcomes of patients who underwent surgery for symptomatic epiretinal membrane (ERM), with or without internal limiting membrane (ILM) peeling.

    Study design

    This single-center, retrospective, consecutive case series included 78 patients with symptomatic ERM. Sixty-one patients had pars plana vitrectomy (PPV) with ILM peeling, and 17 underwent PPV alone. Patients were followed for a minimum of 5 years.


    At postoperative year 5, both groups had significant vision gains as well as comparable visual acuity and macular thickness.

    The study did find a lower recurrence of ERMs requiring surgery in the ILM group at postoperative year 1, but the difference was not significant at postoperative year 5 (1.6% for the ILM group vs. 11.8% for the PPV-only group; P=0.118).


    These findings should be interpreted with caution, per the authors, who indicated that ILM peel may result in a more complete removal of the ERM. In addition, there was a significant disparity in group size.

    Clinical significance

    This is the first study with a 5-year follow-up focusing on the effects of ILM peeling during PPV. At this juncture, real-world changes in surgical technique are unlikely to occur until further data can support moving away from ILM peeling. For now, I will likely continue to peel the ILM until convinced otherwise.