Which of the following is part of ERM treatment?

• A. Monitor, Amsler, Consider PPV with ILM peel if BCVA >20/40 or significant intraretinal cysts
• B. Laser therapy for all cases
• C. Observation only with no Amsler monitoring
• D. Systemic steroids to reduce retina swelling

Answer: (A)

Management of an epiretinal membrane is stepwise: many ERMs are stable and don’t require immediate treatment, so observation with regular functional monitoring is appropriate. Using an Amsler grid helps detect metamorphopsia and subtle changes over time, which might not be evident from acuity measurements alone. When there is enough functional impact or clear structural signs on exam or imaging—such as reduced vision to a level like 20/40 or worse, or significant intraretinal cysts indicating traction—the surgical option is considered. Pars plana vitrectomy with internal limiting membrane peeling relieves the traction on the central retina and often improves or stabilizes vision and metamorphopsia. Laser therapy isn’t effective for ERM because it doesn’t address the tractional membrane, and systemic steroids don’t treat the membrane either. So the approach that emphasizes monitoring with Amsler testing and then considering PPV with ILM peeling for meaningful visual decline or notable macular changes best fits ERM treatment.