ERM and ILM Removal in Only One Step: 2 Years Follow-up on Anatomical and Functional Results



Epiretinal membranes (ERM) are fibrocellular proliferations on the surface of the retina, with contractile properties, that cause metamorphopsia and visual loss. ERM surgery is a demanding state-of-the-art procedure, consisting of ERM, and usually internal limiting membrane (ILM) removal. The use of multiple dyes, or the same dye several times, may cause cellular toxicity. Current evidence suggests that brilliant blue G (BBG) is the least toxic dye, though it on ly dyes the ILM and not the epiretinal membranes. At the same time, the pulling forces exerted on the retina may damage it’s cellular and extracellular components and many authors attest to the fact that ILM peeling may result in localized perimetric defects. Vitreoretinal surgeons continuously seek to perfect their techniques, maximizing results and reducing complications and toxicity. Based on these assumptions and our experience, we present our approach to ERM surgery and our morphological and functional results.


Seven patients with idiopathic epiretinal membrane were selected. We performed small gauge vitrectomy (23G) and peeling of the ERM and ILM, with a double peeling technique, in a single step. We used only BBG to stain the ILM, obtaining a negative staining effect for the ERM. Visual acuity (Snellen chart), macular morphology (SD-OCT) and macular function (Microperimetry) were assessed.


Mean preoperative visual acuity was 0.2, improving to 0.5 at 6 months follow-up and to 0.6 at 2 years follow-up. Mean preoperative macular thickness was 537 μm. At 6 months follow-up the mean macular thickness reduced to 416 μm, and to 362 μm at 2-years follow-up. Macular function assessment by microperimetry also revealed improvement of retinal sensibility at follow-up. There were no intra or postoperative complications and no recurrence of the ERMs.


The authors defend this approach to ERM surgery, always combining ERM removal with ILM peeling in a single double peel technique, and choosing brilliant blue G dye to obtain a negative staining effect, therefore minimizing both retinal damage with surgical instruments and dye toxicity.



Ines Matias
Setubal, Portugal
Email :
Cell Phone: +351919467059
Work Phone: +351265549000