A Novel Surgical Technique for Advanced ERM: Vitrectomy Combined with Perifoveal Centrifugal Massage

Purpose: To investigate the anatomical and functional outcomes of pars plana vitrectomy (PPV) combined with a perifoveal centrifugal massage maneuver in eyes with advanced stage 4 idiopathic epiretinal membrane (iERM) associated with ectopic inner foveal layers (EIFL). Methods: This case series included 40 eyes of 40 patients with idiopathic stage 4 EIFL-ERM who underwent PPV with ERM peeling and adjunctive perifoveal centrifugal massage. Best-corrected visual acuity (BCVA), foveal center point (FCP), central macular thickness (CMT), and EIFL thickness were evaluated at baseline and during follow-up visits at 1, 3, 6, and 12 months, as well as at the final examination. Results: The mean patient age was 68.4±7.9 years, with a mean follow-up of 31.9±17.5 months. Baseline BCVA was 20/95 (0.68±0.32 logMAR). Significant improvement in BCVA was observed from month 3 onward and was maintained at the final visit (p=0.023 at 3 months; p<0.001 thereafter). FCP, CMT, and EIFL thickness showed progressive and significant reductions over time (all p<0.001). Stage transition analysis demonstrated that 22.5% of eyes improved by 3 months, 40.0% by 6 months, 67.5% by 12 months, and 90.0% by the final follow-up. Conclusion: Vitrectomy combined with perifoveal centrifugal massage was associated with favorable anatomical and functional recovery in stage 4 EIFL-ERM. This adjunctive technique may facilitate earlier stage regression and represents a potential refinement to standard iERM surgery.