Qingquan Wei,1,* Chunyang Cai,2,* Lan Yi,1,* Meiling Li,3 Wufeng Zhang,4 Jili Chen,5 Qinghua Qiu1 

1Department of Ophthalmology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Ophthalmology, Shigatse People’s Hospital, Xizang, People’s Republic of China; 4Department of Ophthalmology, Taizhou Fourth People’s Hospital, Taizhou, Jiangsu, People’s Republic of China; 5Department of Ophthalmology, Shibei Hospital Jingan District Shanghai, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Qinghua Qiu, Department of Ophthalmology, Tong Ren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia West Road, Shanghai, People’s Republic of China, Email qinghuaqiu@163.com Jili Chen, Department of Ophthalmology, Shibei Hospital Jingan District Shanghai, 4500 Gonghe Road, Jing’an District, Shanghai, People’s Republic of China, Email corneachen@163.com

Purpose: This study aimed to assess a new three-phase method’s efficacy and safety in treating idiopathic macular epiretinal membrane (ERM).
Methods: The novel technique involved a precise sequence: flap creation - wide margin- extensive peeling. Following the pars plana vitrectomy (PPV), to locate the epiretinal membrane, we stained the internal limiting membrane (ILM) with indocyanine green (ICG), using the stained ILM beneath as a guide to initiate the ERM flap. To minimize the force required for membrane peeling and traction on the underlying retina, we utilized a curved DSP scraper to form a wide-margin parallel arc along the inner aspect of the vascular arcade from the nasal to temporal side. Subsequently, the wide margin of the ERM was grasped tightly with ILM forceps, and traction was applied towards the central macular area to peel off the entire membrane. Finally, ICG staining was applied to ensure that the ERM was completely removed. The technique requires precise mastery of the three-step surgical skills and proficient use of specialized instruments.
Results: In a sample of 55 cases, the surgery achieved significant treatment outcomes. All surgeries were successfully performed with an average duration of 4.23± 0.34 minutes for ERM peeling. At the 12-month postoperative follow-up, the mean logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) significantly improved from 4.74± 0.30 to 4.27± 0.34. The average central macular thickness (CMT) significantly decreased from 503.64± 111.88μm to 353.38± 72.64μm. There are no intraoperative or postoperative complications and there was no recurrence.
Conclusion: The novel technique is a fast, simple, effective and safe surgical technique for treating idiopathic ERM. It significantly improves visual outcomes and reduces the occurrence of complications and recurrence.
Plain Language Summary: The new three-step technique is a fast, simple, and effective surgical method for treating idiopathic ERM. It significantly improves visual outcomes and reduces the occurrence of complications and recurrence.

Keywords: idiopathic epiretinal membrane, internal limiting membrane peeling, surgical technique