Epiretinal membrane (ERM), also known as macular pucker, is a condition where a thin layer of fibrous tissue forms on the macular surface, often causing blurred or distorted central vision. The following information is for educational purposes only and is based on published medical literature. It is not a substitute for personalised medical advice.

1. Not All Epiretinal Membranes Require Surgery


Many ERMs remain stable or cause only mild symptoms. Observation with regular OCT monitoring is appropriate when best-corrected visual acuity is better than 6/12 or when metamorphopsia is minimal [1].

2. Surgery (Vitrectomy with Membrane Peeling) is the Only Established Treatment


No pharmacological or non-surgical treatments have been proven to remove an epiretinal membrane or reliably improve vision [2].

3. High Anatomical Success and Frequent Visual Improvement


Modern small-gauge vitrectomy achieves macular flattening in 90–95% of cases. Approximately 75–85% of patients gain ≥2 lines of vision, 10–15% remain stable, and <5% lose vision (usually due to underlying macular pathology) [3,4].

4. Visual Recovery is Gradual


Maximum visual improvement typically occurs between 3 and 12 months, with the majority of recoverable vision returning by 6–9 months [5].

5. Cataract Progression is Common After Vitrectomy in Phakic Patients


In patients over 50 years with a clear natural lens, cataract requiring surgery develops in >80% within 2 years. Combined vitrectomy–cataract surgery is frequently offered [6].

6. Day Surgery Under Local Anaesthesia is Standard


In Singapore, ERM surgery is routinely performed under local anaesthesia with monitored sedation as an ambulatory procedure lasting 20–40 minutes [7].

7. Face-Down Posturing is Not Required


Unlike macular hole surgery, pure epiretinal membrane peeling does not involve gas tamponade or mandatory face-down positioning [8].

8. Complications Are Uncommon but Possible


Reported rates in large series:


• Endophthalmitis: ~0.02–0.04% (1 in 2,500–5,000)


• Retinal detachment: 1–2%


• ERM recurrence: 5–10% at 5–10 years [3,9]

9. Cost Considerations in Singapore (caa 2025)


Costs vary widely depending on subsidised vs private care, hospital class, and whether combined cataract surgery is performed. Medisave withdrawal limits for vitreoretinal surgery are up to $3,610 per eye (as of 2025), and Integrated Shield Plans provide variable coverage [10].

10. Duration of Symptoms Influences Final Visual Outcome


Longer preoperative symptom duration and more severe macular distortion are associated with reduced visual gain. Best results are generally seen when surgery is performed within 6–12 months of significant symptoms [11].

References

1. Wong J, et al. Clin Exp Ophthalmol 2017;45:496–507.

2. Folk JC, et al. Ophthalmology 2019.

3. Rahman R, Stephenson J. Eye (Lond) 2020;34:1410–1416.

4. Garweg JG, et al. Ophthalmologica 2021;244:422–435.

5. Inoue M, et al. Retina 2013;33:1609–1615.

6. Jackson TL, et al. Ophthalmology 2013;120:629–634.

7. Tan HS, et al. Retina 2018;38:1678–1684.

8. Heath G, Rahman R. Eye 2012;26:1410–1415.

9. Guber J, et al. Retina 2020;40:1298–1303.

10. Ministry of Health Singapore – Table of Surgical Procedures & Medisave limits (2024–2025).

11. Steel DH, et al. Br J Ophthalmol 2021;105:1588–1593.

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This article contains general educational information only. All treatment decisions must be made in consultation with a qualified ophthalmologist after a complete clinical examination.