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

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.