• Retina/Vitreous

    This systematic review and meta-analysis of the literature evaluated whether combined epithelial retinal membrane (ERM) and internal limiting membrane (ILM) peeling offered advantages in postoperative visual outcomes over ERM peeling alone.

    Study design

    The analysis included 7 randomized controlled trials conducted in patients (387 eyes) with idiopathic ERM who had pars plana vitrectomy for ERM peeling. Investigators focused their data review on functional and anatomical outcomes and rates of idiopathic ERM recurrence in the 2 treatment populations.


    Results from the included studies indicated that ERM recurrence rates were significantly lower in patients given combined ERM/ILM peeling (relative risk 0.16 at 6–12 months) than in patients given ERM peel alone. However, ERM/ILM peeling was associated with increased central macular thickness at 12 months postoperatively (difference from ERM peeling alone: 20.53). These differences in anatomical outcomes did not cause a significant difference in the final visual acuity between the 2 groups.


    The studies analyzed did not specify the morphologic features of the increased central foveal thickness in the ERM/ILM group; thus, it is difficult to understand the cause of this anatomic difference between the two groups. In addition, studies with longer follow-up times would be useful in providing greater information about rates of ERM recurrence.

    Clinical significance

    As ERM/ILM peeling led to visual outcomes similar to those seen with ERM peeling alone but with a decreased ERM recurrence rate, it makes sense to consider ILM peeling to help prevent the need for repeat surgery.