Background: Epiretinal membrane (ERM) is a fibrocellular preretinal proliferation composed of fibroblasts, glial cells, and hyalocytes overlying the internal limiting membrane. Pars plana vitrectomy (PPV) with membrane peeling is the standard surgical treatment, but postoperative cystoid macular edema (CME) can limit visual recovery. Inflammation plays a key role in CME pathogenesis, and corticosteroids may help reduce the inflammatory response associated with both ERM-related traction and surgical trauma. Therefore, sustained-release dexamethasone (DEX) intravitreal implants have been investigated as an adjunct to surgery. Methods: This SANRA-guided narrative review evaluated studies investigating DEX implantation during PPV for ERM surgery or as treatment for persistent postoperative CME. Eligible studies included human clinical studies reporting functional, anatomical, biomarker, or safety outcomes following DEX use in the ERM surgical setting. Results: DEX implantation appears to promote faster resolution of postoperative inflammation and CME, with consistent improvements in anatomical parameters such as central macular thickness. However, the impact on visual acuity remains variable, with some studies reporting earlier functional recovery and others showing no significant long-term benefit. Reported adverse events mainly include intraocular pressure elevation manageable with medical therapy and cataract progression. Available evidence suggests that intraoperative DEX implantation is associated with more consistent anatomical benefit than superior long-term functional improvement, while delayed DEX administration may benefit selected eyes with persistent postoperative cystoid macular edema. Conclusions: Current evidence suggests that DEX implantation may represent a potentially useful adjunctive strategy in selected patients undergoing ERM surgery, particularly in eyes at higher risk of postoperative inflammation or cystoid macular edema. While available studies suggest potential anatomical benefits, evidence regarding superior long-term functional outcomes remains inconsistent. Moreover, while current evidence suggests that DEX implantation may accelerate anatomical recovery and improve postoperative inflammatory control in selected patients, long-term functional superiority over PPV alone, including sustained BCVA improvement and patient-reported visual outcomes such as metamorphopsia, remains unproven. Larger prospective randomized studies are needed to better define optimal patient selection and treatment timing.

Background: Symptomatic vitreous floaters are generally considered benign and self-limiting, especially in young individuals. However, persistent symptoms can sig-nificantly impair vision and quality of life, even when best-corrected visual acuity (BCVA) is preserved. Long-term data on pars plana vitrectomy (PPV) for floaters in young patients remain limited. Methods: This retrospective observational study included patients under 50 years old affected by persistent symptomatic vitreous floaters for at least 24 months who underwent PPV over 10 years at a single tertiary referral center. All eyes had undergone a stand-ardized 25-gauge vitrectomy. If posterior vitreous detachment (PVD) was absent, it was induced. Next, the vitreous base was shaved, the peripheral retina was inspected, and endolaser was applied as indicated. Air tamponade was used at the surgeon’s discretion and was always applied for retinal breaks. Results: Eighty-nine eyes were included. Mean age at surgery was 37.0 ± 7.0 years, with 59.6% of patients under 40 years old. The median duration of symptoms before surgery was 32 months (27–48). Preoperative BCVA was preserved in almost all eyes and re-mained stable postoperatively, with a mean change of +0.03 logMAR. The median fol-low-up was 60 months (58–72). No cases of rhegmatogenous retinal detachment, new-onset glaucoma, or visually significant cataract needing surgery were observed. Postoperative complications included endophthalmitis in one eye, macular hole in one eye, and permanent visual field defects in two eyes due to optic nerve touch during PVD induction. Importantly, no eye required reintervention for recurrent symptomatic floaters. Conclusions: Symptomatic vitreous floaters may persist for years in some young patients. Surgery may be considered when symptoms are significant. In this series, complete PPV with PVD induction provided stable BCVA and anatomical outcomes, with no reinter-vention for recurrent visually disturbing floaters. However, serious complications show that this elective procedure carries real risks.

Retinal detachment (RD) is a potentially sight-threatening condition that requires timely diagnosis and appropriate surgical management. In macula-off rhegmatogenous retinal detachment (RRD), visual recovery after successful reattachment remains highly variable, highlighting the need for reliable preoperative prognostic markers. This study focuses on the contribution of advanced retinal imaging to the preoperative assessment of macula-off RRD, summarizing current evidence on imaging-derived biomarkers associated with disease severity and postoperative functional outcome. In this narrative review, we analyze studies employing spectral-domain and swept-source optical coherence tomography (SD-OCT and SS-OCT), OCT angiography (OCT-A), and adaptive optics OCT (AO-OCT) to characterize microstructural and microvascular retinal alterations. Emerging approaches, including ultra-widefield OCT (UWF-OCT) and artificial intelligence-based image analysis, are also discussed for their potential role in refining diagnosis, supporting surgical planning, and improving prognostic stratification. While several imaging parameters appear promising, their prognostic value is not yet fully realized. Further prospective studies are required to validate clinically meaningful imaging biomarkers and to integrate advanced imaging into routine preoperative decision-making for macula-off RRD.

Retinal detachment (RD) is a potentially sight-threatening condition that requires timely diagnosis and appropriate surgical management. In macula-off rhegmatogenous retinal detachment (RRD), visual recovery after successful reattachment remains highly variable, underscoring the need for reliable preoperative prognostic markers. This study focuses on the contribution of advanced retinal imaging to the preoperative assessment of macula-off RRD, summarizing current evidence on imaging-derived biomarkers associated with disease severity and postoperative functional outcome. In this review, we analyze studies employing spectral-domain and swept-source optical coherence tomography (SD-OCT and SS-OCT), OCT angiography (OCT-A), and adaptive optics OCT (AO-OCT) to characterize microstructural and microvascular retinal alterations. Emerging approaches, including ultra-widefield OCT (UWF-OCT) and artificial intelligence–based image analysis, are also discussed for their potential role in refining diagnosis, supporting surgical planning, and improving prognostic stratification. While several imaging parameters appear promising, their prognostic value is not yet fully standardized. Further prospective studies are required to validate clinically meaningful imaging biomarkers and to integrate advanced imaging into routine preoperative decision-making for macula-off rhegmatogenous retinal detachment.

Background: Epiretinal membrane (ERM) is a fibrocellular preretinal proliferation composed of fibroblasts, glial cells, and hyalocytes overlying the internal limiting membrane. Pars plana vitrectomy (PPV) with membrane peeling is the standard surgical treatment, but postoperative cystoid macular edema (CME) can limit visual recovery. Inflammation plays a key role in CME pathogenesis, and corticosteroids may help reduce the inflammatory response associated with both ERM-related traction and surgical trauma. Therefore sustained-release dexamethasone (DEX) intravitreal implants have been investigated as an adjunct to surgery. Methods: A narrative review of the literature was conducted using PubMed and Embase databases up to January 2025. Studies evaluating DEX implants in conjunction with PPV and ERM peeling were included. Both prospective and retrospective clinical studies were considered, in accordance with SANRA recommendations. Results: DEX implantation appears to promote faster resolution of postoperative inflammation and CME, with consistent improvements in anatomical parameters such as central macular thickness. However, the impact on visual acuity remains variable, with some studies reporting earlier functional recovery and others showing no significant long-term benefit. Reported adverse events mainly include intraocular pressure elevation manageable with medical therapy and cataract progression. Conclusions: DEX implant appears to be a safe and potentially effective adjunct to PPV with membrane peeling for ERM, particularly in high-risk eyes, although further large, prospective randomized studies are needed to better define its role.