Impact of epiretinal membrane surgery on glaucoma progression: influence of glaucoma severity and internal limiting membrane peeling

Background This retrospective, comparative study evaluated the long-term impact of pars plana vitrectomy (PPV) for epiretinal membrane (ERM) removal on glaucoma progression, focusing on the influence of glaucoma severity and adjunctive internal limiting membrane (ILM) peeling. Methods A total of 231 eyes from patients diagnosed with primary open-angle glaucoma and coexisting ERM were included. Participants were divided into two groups: 114 eyes underwent PPV for ERM removal (PPV group) and 117 eyes did not undergo surgery (non-PPV group). The PPV group was further subdivided based on glaucoma severity and ILM peeling. Functional and structural parameters were assessed over 4 years using visual field testing, intraocular pressure (IOP) measurement, and optical coherence tomography. Linear mixed models were used for statistical analysis. Results The PPV group demonstrated a significant deterioration in mean deviation and visual field index, compared with the non-PPV group, over 4 years (p<0.001). However, the rate of progression did not differ significantly based on glaucoma severity. Patients with severe glaucoma experienced a relatively greater functional burden. Adjunctive ILM peeling did not worsen functional or structural outcomes. IOP and medication use remained stable throughout the study period. Conclusions While associated with long-term visual field decline, PPV for symptomatic ERM demonstrates a consistent impact on glaucoma progression, irrespective of baseline disease severity. ILM peeling does not confer additional risk. These findings support individualised surgical decision-making based on patient symptoms rather than glaucoma stage alone.