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

## TL;DR

This review examines how effective and cost-effective vitrectomy surgery is for treating eye membranes in people over 50.

## Contribution

The study systematically reviews both the visual and cost-effectiveness of vitrectomy for iERMs.

## Key findings

- Vitrectomy improved visual acuity, but a randomized trial found no significant difference compared to watchful waiting.
- Vitrectomy was found to be cost-effective in one study with a ratio of $4680 per quality-adjusted life year gained.
- Quality of life improved significantly at 3 and 12 months post-surgery based on patient-reported outcomes.

## Abstract

Primary idiopathic epiretinal membrane (iERM) is a common finding in people aged 50 years or over. It is treated with vitrectomy. There are no definite criteria for when to conduct surgery, and outcomes are variable. This systematic review assessed the effectiveness and cost‐effectiveness of vitrectomy surgery for iERM.

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. The efficacy endpoint was the mean change in best‐corrected visual acuity (BCVA) from baseline. Summarising effect estimates were used to synthesise results.

Twelve included studies (11 case series and 1 RCT) met the eligibility criteria. The length of the follow‐up ranged from 1 week to 2 years after surgery. The majority of studies were carried out in Asia. Vitrectomy showed improvement in BCVA from baseline. The 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). The RCT showed no significant difference between surgery and watchful waiting. Three 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. The composite scores of NEI‐VFQ‐25 were significantly improved at 3 and 12 months after surgery. Vitrectomy surgery was found to be cost‐effective in one included study, with an incremental cost‐effectiveness ratio of $4680 per quality‐adjusted life year gained.

Vitrectomy surgery demonstrated improvement in BCVA from baseline, but the RCT with a watchful waiting group showed no significant difference. Vitrectomy surgery was cost‐effective. An RCT comparing iERM vitrectomy surgery and either delayed surgery or no surgery, and a health economics evaluation of the intervention are needed to confirm the effectiveness and cost‐effectiveness of iERM vitrectomy surgery.