What question did this study set out to answer?

To assess the effectiveness of an OCT-guided approach for epiretinal membrane surgery compared to conventional methods.

April 7, 2026

Preoperative Classification of Submembrane Spaces for Optical Coherence Tomography–Guided Epiretinal Membranectomy

Key Points

To assess the effectiveness of an OCT-guided approach for epiretinal membrane surgery compared to conventional methods.
Retrospective, comparative case series design
137 eyes undergoing OCT-guided ERM surgery vs. 71 controls
Submembrane spaces classified into 4 categories using spectral-domain OCT
Main outcomes included first-attempt success and complications
Significantly higher first-attempt success in the OCT group (89.2% vs 57.2%)
Lower rates of petechial hemorrhage (40.0% vs 85.0%)
0% macular breaks in the OCT group vs 8.0% in controls
Mean operative time reduced by 28% (19.6 min vs 25.1 min)
Greater visual improvement at 3 months in the guided group (+16.2 vs +11.2 ETDRS letters)

Abstract

Purpose: To evaluate optical coherence tomography (OCT)-guided epiretinal membrane (ERM) surgery using the preoperative retinal evaluation system for surgery classification in a retrospective, comparative case series. Methods : In a masked study, 137 eyes undergoing ERM surgery with this OCT-guided system were compared with 71 consecutive controls undergoing conventional surgery. Using spectral-domain OCT, ERMs were preoperatively classified into 4 categories based on submembrane space characteristics, allowing for a tailored surgical approach. Main outcomes included first-attempt success, surgical complications, and 3-month visual acuity. Results : Compared with controls, patients receiving our OCT-guided approach had significantly higher first-attempt success (89.2% vs 57.2%; P < . 001) and lower rates of petechial hemorrhage (40.0% vs 85.0%; P < . 001) and macular breaks (0% vs 8.0%; P < . 001). First-attempt success varied by class ( P < . 01), and mean operative time was reduced by 28% (19.6 vs 25.1 min; P < . 001). Visual improvement was significantly greater in the guided group at 3 months (+16.2 vs +11.2 ETDRS letters; P < . 01). Conclusions : The preoperative retinal evaluation system for surgery classification provides a practical framework for surgical planning in ERM cases. This OCT-guided approach helps stratify surgical risk, identify optimal engagement points, increase efficiency, and guide technique selection. Preoperative OCT-guided planning offers significant advantages over conventional methods, resulting in improved success rates and reduced complications.

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