**Abstract**

The primary management for epiretinal membrane (ERM) is membrane peel after pars plana vitrectomy. However, the rates of postoperative recurrence of epiretinal membrane reported range from 10 to 21%. Internal limiting membrane (ILM) peeling combined with ERM removal has been introduced in an attempt to diminish this recurrence. Some studies showed that this method largely prevented the recurrence compared with those without ILM peeling. Conversely, other studies demonstrated that combined ERM and ILM peeling did not provide a lower recurrence rate. Since the ILM is formed by the basal lamina of Muller cells, removal of this structure must be pondered due to possible mechanical and functional damage to those important cells. In this chapter, current data on this topic are covered.

**Keywords:** epiretinal membrane peeling, internal limiting membrane, epiretinal membrane recurrence, idiopathic epiretinal membrane, epiretinal membrane (ERM)

## **1. Introduction**

Epiretinal membrane is a prevalent disease [1, 2]. Studies that incorporated ocular coherence tomography (OCT) for detection found a higher prevalence of this pathology, ranging from 3.4 [3] to 34.1% [4].

Most epiretinal membrane (ERM) is idiopathic and increasing age is the most important risk factor, with most patients presenting over 50 years and a peak prevalence in the 7th decade [5, 6]. There is great variability in the reported prevalence of ERM among different racial groups, although studies using similar methodologies reported a higher prevalence in Asians [7, 8].

Vitrectomy with membrane peeling remains the mainstay of treatment for symptomatic ERMs. First, a three ports pars plana vitrectomy is performed and then the ERM is peeled. Dyes are often used to better visualize the ERM and the internal limiting membrane (ILM).
