The Visual Effectiveness and Cost-Effectiveness of Vitrectomy and Membrane Peeling for Primary Idiopathic Epiretinal Membranes (iERMs): A Systematic Review

Sep 29, 2026

Uploaded by Mary Man

Primary idiopathic epiretinal membrane (iERM) is common in people aged 50 years or over and is typically treated with vitrectomy, yet there are no definite surgical timing criteria and outcomes vary. This systematic review evaluates the effectiveness and cost-effectiveness of vitrectomy surgery for iERM by synthesizing evidence from included clinical and health economics studies, focusing on visual acuity and patient-reported vision-related quality of life outcomes.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Introduction

Clinical background and rationale

Materials and Methods

Review protocol and search strategy

Results

Included studies and efficacy endpoints

Patient-reported outcomes and cost-effectiveness

Conclusion

Wiley Journal of Ophthalmology Volume 2026, Article ID 5546933, 11 pages [https://doi.org/10.1155/joph/5546933](https://doi.org/10.1155/joph/5546933) Review Article The Visual Effectiveness and Cost-Effectiveness of Vitrectomy and Membrane Peeling for Primary Idiopathic Epiretinal Membranes (iERMs): A Systematic Review Kodchawan Doungsong , 1 Hoi To Kwong,2 Teresa Sandinha ,2,3 David H. Steel ,4 Ned Hartfel , 1 and Rhiannon Tudor Edwards 1 1 Centre for Health Economics and Medicine Evaluation, Bangor University, Bangor, UK 2 University of Liverpool Department of Eye and Vision Science, University of Liverpool, Liverpool, UK 3 Royal Liverpool University Hospital Saint Paul’s Eye Unit, University of Liverpool, Liverpool, UK 4 Newcastle University Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK Correspondence should be addressed to Kodchawan Doungsong; [pim.doungsong@bangor.ac.uk](pim.doungsong@bangor.ac.uk) Received 16 April 2025; Revised 2 November 2025; Accepted 15 December 2025 Academic Editor: Shweta Negi Copyright © 2026 Kodchawan Doungsong et al. Journal of Ophthalmology published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Introduction: Primary idiopathic epiretinal membrane (iERM) is a common fnding in people aged 50 years or over. It is treated with vitrectomy. Tere are no defnite criteria for when to conduct surgery, and outcomes are variable. Tis systematic review assessed the efectiveness and cost-efectiveness of vitrectomy surgery for iERM. Material and Methods: Medline, Embase, Cochrane Library and Scopus were searched. Prospective cohort studies, randomised controlled trials (RCTs) and health economics studies published from 2000 to May 2024 were included. Te efcacy endpoint was the mean change in best-corrected visual acuity (BCVA) from baseline. Summarising efect estimates were used to synthesise results. Results: Twelve included studies (11 case series and 1 RCT) met the eligibility criteria. Te length of the follow-up ranged from 1 week to 2 years after surgery. Te majority of studies were carried out in Asia. Vitrectomy showed improvement in BCVA from baseline. Te studies exhibited a wide range in the mean change of BCVA, with the greatest median change 12 months after surgery (0.29, IQR: 0.065). Te RCT showed no signifcant diference between surgery and watchful waiting. Tree studies used the National Eye Institute 25-Item Visual Function Questionnaire (NEI-VFQ-25) as their only patient-reported outcome to measure vision-related quality of life for iERM. Te composite scores of NEI-VFQ-25 were signifcantly improved at 3 and 12 months after surgery. Vitrectomy surgery was found to be cost-efective in one included study, with an incremental cost-efectiveness ratio of $4680 per quality-adjusted life year gained. Conclusion: Vitrectomy surgery demonstrated improvement in BCVA from baseline, but the RCTwith a watchful waiting group showed no signifcant diference. Vitrectomy surgery was cost-efective. An RCT comparing iERM vitrectomy surgery and either delayed surgery or no surgery, and a health economics evaluation of the intervention are needed to confrm the efectiveness and cost-efectiveness of iERM vitrectomy surgery. Keywords: cost-efectiveness; health economics; idiopathic epiretinal membrane; systematic review; vitrectomy 2 Journal of Ophthalmology 1. Introduction Te overarching question this systematic review aims to answer is: Primary idiopathic epiretinal membrane (iERM), or pre- What is the efectiveness and cost-efectiveness of sur macular membrane, is a common fnding that is present in gery on iERMs? up to 34% of people aged 60 or over [1, 2] . iERM refers to Te sub-questions were: a thinmaculalayinertohfe parbesreetinncealosfcaotrhteissrueeyeordimemseasebr

FAQs

What clinical question does the systematic review address for iERMs?

It assesses the effectiveness and cost-effectiveness of vitrectomy surgery for primary idiopathic epiretinal membranes (iERMs).

How was surgical effectiveness measured in the review?

Effectiveness was summarized using the mean change in best-corrected visual acuity (BCVA) from baseline, with synthesis of estimated effects across included studies.

What did the review find about cost-effectiveness and trial comparisons?

One included study found vitrectomy to be cost-effective, while the RCT showed no significant difference between surgery and watchful waiting.

Sep 29, 2026

Uploaded by Mary Man