Epiretinal membrane surgery is a demanding, state-of-the-art procedure. Vitreoretinal surgeons continuously seek to perfect their results, maximizing results and reducing complications and toxicity. Based on our belief and experience of the benefits of combined ERM and ILM peeling when removal of the former is indicated, we present our technique that we believe is both effective and safe.


We present our adopted approach to ERM surgery, based in three main principles:

  1. We always combine ERM peeling with ILM peeling, as a way to prevent the reported up to 16-20% recurrence rate of ERM.
  2. To minimize the retinal damage caused by the repetitive grasping, we perform a double peeling technique in a single step, removing both membranes at the same time, initiating the grasp either in the temporal macula or in a previously identified detached spot with the OCT en face.
  3. To minimize toxicity, and since we aim to remove the ERM along with the ILM, we prefer to use only brilliant blue G (with or without lutein or bromphenol blue) and dye the ILM, therefore obtaining a “negative staining” technique for the ERM. Using Brilliant Blue G is sufficient for this approach, and recent studies suggest a significantly reduced retinal toxicity when compared with other frequently used dyes (i.e trypan blue or ICG), while providing excellent ILM visualization.


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, therefore minimizing both retinal damage with surgical instruments and dye toxicity.

Contact Details:

Cell Phone: +351964029156

David da Fonseca Martins