Macula-vitreous interface vitrectomy for pediatric epiretinal membrane: surgical principles, clinical outcomes and safety profile.

PURPOSES: To describe the surgical technique of Macula-Vitreous Interface Vitrectomy (MVIV), and report its clinical outcomes in pediatric patients with non-inflammatory epiretinal membrane (ERM). METHODS: This single-center retrospective case series included 42 pediatric patients (3 to 14 years) with unilateral non-inflammatory ERM who underwent MVIV between 2018 and 2023. MVIV involved selective removal of vitreous adjacent to the vitreomacular interface, primarily around the optic disc and macula within the vascular arcades, while preserving the central and peripheral vitreous. Outcomes included best-corrected visual acuity (BCVA), optical coherence tomography (OCT) parameters [central foveal thickness (CFT) or lesion thickness (LT)], intraocular pressure (IOP), and postoperative complications. RESULTS: Mean age at surgery was 7.63 ± 2.97 years, with mean follow-up of 22.96 ± 11.43 months. BCVA improved from a median of 0.82 (IQR, 0.70-1.30) to 0.70 (IQR, 0.49-0.85), at 12 months (Hodges-Lehmann estimate, -0.20 logMAR; 95% CI, -0.29 to -0.10; P < .001).CFT/LT decreased significantly (both P < .001). ERM recurred in one eye (2.4%). No postoperative cataract, retinal detachment, proliferative vitreoretinopathy, or sustained IOP abnormalities were identified. CONCLUSIONS: MVIV was associated with favorable anatomical and visual outcomes and few short- and medium-term postoperative complications in this cohort. These findings support the feasibility of MVIV as a surgical option for selected pediatric patients with non-inflammatory ERM. Further comparative studies with longer follow-up are warranted to define its role relative to conventional vitrectomy techniques.