Epiretinal membrane and senile cataract: combined vs sequential surgery

Purpose: To evaluate the outcomes of combined phacovitrectomy versus sequential phacoemulsification and vitrectomy in patients with both senile cataract and epiretinal membrane (ERM). Methods: A retrospective multicenter study was conducted between 2014 and 2022 at two hospitals in Italy. Patients with idiopathic ERM and senile cataract in the same eye were enrolled and underwent either combined (n=38) or sequential surgery (n=38), performed by a single surgeon. Best corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at 1, 3, and 6 months after surgery. Results: Both surgical approaches significantly improved BCVA and reduced CMT after 6 months. However, sequential surgery showed faster visual recovery, with significant improvements in BCVA (P=0.008) and CMT (P<0.0001) observed as early as 1-month post-surgery, compared to the combined group. Conclusion: Although both surgical approaches yielded significant improvements in visual acuity and central macular thickness at 6 months, the sequential approach offered a faster recovery in the early postoperative period. According to the literature, the sequential approach also allows some patients to be satisfied after cataract surgery alone, potentially avoiding unnecessary vitrectomy and reducing the risk of overtreatment.