Do you routinely perform ILM peeling in all epiretinal membrane (ERM) cases or do you selectively peel based on OCT features and membrane characteristics?

With rare exceptions, I peel ILM in all ERM cases for two main reasons. First, it is the best way (and in some cases the only way) to ensure that the ERM is removed completely, thereby avoiding the postoperative scenario of persistent ERM causing persistent visual symptoms. Second, there is good evidence that removing the ILM along with the ERM virtually eliminates the possibility of recurrent ERM formation (because it thoroughly removes the thin layer of cortical vitreous that is found between ...

The introduction of membrane-staining dyes has fundamentally changed my approach to epiretinal membrane (ERM) removal. Rather than search for edges or pinch areas of suspected membranes, my surgical approach to ERM removal is now as follows:

1. For easily visualized, translucent ERMs, I remove the membrane primarily without concern for the ILM.

2. For transparent, difficult-to-see ERMs, which constitute most of the membranes for which I do surgery, I instill Tissue Blue and initiate peeling by gra...