**Surgical Management of Epiretinal Membrane**

Miltiadis K. Tsilimbaris, Chrysanthi Tsika, George Kontadakis and Athanassios Giarmoukakis

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/60513

#### **Abstract**

Epiretinal membranes (ERMs) are contractile membranes that occur on the inner surface of the retina and can lead to significant visual impairment when located at the central retina. Recent advances in vitreoretinal surgery have greatly improved the safety and efficacy of microsurgical intervention at the retinal surface level. Today, vitrectomy and membrane peels are considered the treatment of choice for most patients with ERMs that create significant visual symptoms. Nevertheless, possible complications such as accelerated cataract formation, recurrence of ERM and retinal detachment may withhold the choice of surgical intervention. Additionally, in some cases, simple observation may be advised. In view of surgery, controversies regarding techniques such as those related to an internal limiting membrane peel and the use of dye still exist. In this chapter, we cover current surgical techniques for ERM removal, their expected results, possible complications, as well as a guide for possible case selection.

**Keywords:** Epiretinal membrane, surgical management, patient selection

#### **1. Introduction**

#### **1.1. Classification**

The disease entity of epiretinal membrane (ERM) proliferation was first described in 1865 by Iwanoff [1]. It is caused by the proliferation of avascular cellular sheets on the inner retinal surface and along the internal limiting membrane (ILM), which possesses contractile proper‐

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ties and as a result, leads to variable visual symptoms and visual impairments, primarily due to the mechanical distortion of the macular area. The condition's variable effect on vision is determined primarily by the severity of the retinal distortion and the location of the membrane.

ERMs can be classified according to their underlying aetiology into: a) primary or idiopathic ERMs (iERMs) [2], when no underlying causative factor or ocular pathology can be associated with the membrane formation; b) secondary ERMs, which are commonly found in association with retinal breaks and retinal detachment (RD), RD surgical repair, laser photocoagulation, retinal cryopexy, proliferative vitreoretinopathy (PVR), retinal vascular diseases, intraocular inflammation and ocular trauma [3-7]. Additionally, international literature describes rare cases of secondary ERM formation associated with type-2 neurofibromatosis [8]. In addition to the etiological classification, Gass proposed a clinical classification of ERMs based on biomicroscopical findings [9], according to which ERMs can be differentiated into three grades:

