Abstract
Purpose
Laser photocoagulation remains the most common treatment for peripheral retinal degeneration. However, potential side effects, particularly inflammation and gliosis, raise concerns about an increased risk of epiretinal membrane (ERM) formation. This study aims to further investigate the association between laser photocoagulation and ERM formation and identify associated risk factors.
Methods
This retrospective study included patients who underwent retinal laser photocoagulation for peripheral retinal degeneration. Clinical data including medical history, ophthalmic examinations during follow-up, and details of the laser photocoagulation, were recorded. Binary regression analysis was used to assess risk factors for ERM formation, including age, ocular findings, and laser parameters.
Results
Among the 726 eyes, 32 eyes (4.41%) developed ERM during a follow-up period of 29.7 ± 17.2 months. Risk factors included older age (53.9 ± 11.1 vs. 36.6 ± 17.3 years, P < 0.001), presence of lattice degeneration (62.5% vs. 40.3%, P < 0.001), greater number of laser spots (390.1 ± 171.9 vs. 284.8 ± 156.4, P < 0.001), higher total laser energy (22.5 ± 10.8J vs. 13.6 ± 11.9J, P < 0.001), wider extent of laser coverage (4.47 ± 3.38 vs. 3.08 ± 2.10 clock hours, P = 0.028), and shorter distance between the laser and the fovea (7.50 ± 1.72 vs. 8.36 ± 2.16 disc diameters, P = 0.017). Further regression analysis identified age (OR 1.071, 95% CI 1.040–1.102), number of laser spots (OR 1.003, 95% CI 1.001–1.005), and extent of laser coverage (OR 1.178, 95% CI 1.025–1.354) as independent risk factors for ERM development.
Conclusions
Peripheral retinal laser photocoagulation does not significantly increase the incidence of ERM. However, careful control of the number and extent of laser applications may help minimize potential damage to the macula.
Subject terms: Retinal diseases, Risk factors, Epidemiology
Introduction
Peripheral retinal degeneration, particularly lattice degeneration, is a risk factor for retinal tears and rhegmatogenous retinal detachment [1]. Laser photocoagulation remains a simple and effective treatment for peripheral retinal degeneration [2]. This procedure uses high-energy laser beams to produce thermal burns at the edges of degenerated areas, which creates a biological thermocoagulation effect and induces a localized sterile inflammatory response [3]. This promotes adhesion between the neurosensory retina, the retinal pigment epithelium (RPE), and the underlying choroid, thereby reducing the risk of retinal detachment from ~50% to 5% [4].
However, the thermocoagulation effect of the laser can lead to localized exudative choroiditis, as well as the upregulation of inflammatory factors and activation of glial cells [5, 6]. The inflammatory response may extend to the macular region, which is one of the causes of secondary epiretinal membrane (ERM) formation [7]. In addition, laser-induced damage to the retinal blood barrier function may provoke or exacerbate macular oedema, which has been demonstrated in studies on diabetic retinopathy [5]. Although these side effects are probably transient and self-limiting [8], some studies have suggested potential correlation between laser therapy and an increased risk of ERM formation. Reported incidences of ERM following laser photocoagulation vary widely, ranging from 0% to 18.2% [9–15]. The variability may be attributed to limitations in diagnostic techniques in earlier years, as well as the heterogeneous follow-up durations across studies.
In this study, we reviewed a cohort of patients diagnosed with peripheral retinal degeneration who had normal macular microstructure and visual function and analyse the incidence and risk factors of ERM formation within several years following retinal laser photocoagulation. We aim to explore the correlation between retinal photocoagulation and ERM formation, and to provide a theoretical basis for treatment strategies for peripheral retinal laser photocoagulation in order to reduce its potential damage to macula.
Subjects and methods
Participants and ethics approval
This retrospective cohort study conformed to the guidelines of the Declaration of Helsinki. The research was conducted in compliance with a suitable accredited institutional review board (IRB) from the Ethics Committee of Joint Shantou International Eye Center (JSIEC) of Shantou University and the Chinese University of Hong Kong (IRB No. EC20221115(10)-P16). Informed consent was waived by the IRB of JSIEC as it was a retrospective study. Consecutive patients at JSIEC who underwent peripheral laser photocoagulation for peripheral retinal degeneration between January 2018 and December 2019 were included in this study. Inclusion criteria were: 1) Age over 18 years; 2) Diagnosed with peripheral retinal degeneration, including lattice degeneration, paving stone degeneration, reticular degeneration, cystoid degeneration, and frosted branch angiitis-like degeneration requiring laser photocoagulation; 3) A best-corrected visual acuity (BCVA) of 0.1 logMAR or better before laser photocoagulation; 4) No diagnosis of ERM prior to laser treatment based on optical coherence tomography (OCT) or funduscopy results; 5) A follow-up of at least six months after laser treatment; 6) If both eyes met the above criteria, one eye was randomly selected using a computer-generated random number method for inclusion in the study. Exclusion criteria: 1) Presence of ERM at the time of laser treatment; 2) Presence of other ocular diseases, including but not limited to uveitis, diabetic retinopathy, retinal vein occlusion, or age-related macular degeneration; 3) Presence of retinal breaks/tears or retinal detachment; 5) A history of intraocular surgery (excluding cataract surgery performed more than six months prior).
Furthermore, to investigate whether retinal laser photocoagulation is a risk factor for ERM, we also review a group of patients diagnosed with ERM conformed by OCT between January 2022 and December 2024, as well as a control group of patients confirmed to have no ERM based on OCT examinations during the same period, and compared the history of retinal laser photocoagulation performed for retinal degeneration between the two groups.
Data collection
The following data were collected from clinical charts: age, gender, BCVA, pseudophakic eyes, refractive status (with a spherical equivalent <−6.00 dioptres and/or or an axial length of >26 millimetres defined as high myopia), and the use of anti-inflammatory medications after laser treatment. Scanning laser ophthalmoscopy (SLO) was used to confirm the location and extent of retinal degeneration, as well as to evaluate the outcomes after laser treatment. OCT was utilized to confirm the presence and progression of ERM formation and to assess its progression. Treatment and follow-up information, including progression of the ERM and whether vitreoretinal surgery was performed, were collected.
The parameters of laser treatment were reviewed, including: 1) Number of laser spots; 2) Single-spot laser power, referring to the energy used during the procedure; 3) Total energy, defined as the product of the number of laser spots and the single-spot power; 4) Extent of laser treatment, evaluated by the number of clock-hour sectors involved (the retina is divided into 12 clock-hour sectors); 5) Location of laser treatment, recorded as superior, nasal and temporal, inferior, or multiple quadrants; 6) Shortest distance between the laser spots and the macular fovea, measured using optic disc diameters (DD) as a unit.
Diagnosis and classification of ERM
The primary outcome measures of this study were the incidence rate of ERM formation following laser photocoagulation and its associated risk factors. The diagnosis and classification of an ERM were made based on OCT results. Two OCT devices were used in this study: Cirrus HD-OCT 4000/5000 (Carl Zeiss Meditec, Dublin, CA, USA), and Topcon Triton (Topcon Corporation, Tokyo, Japan).
ERM was classified into four stages according to the Govetto’s ERM grading system: Stage 1, presence of the foveal pit with well-preserved retinal layers; Stage 2, absence of the foveal pit; Stage 3, presence of ectopic inner foveal layers; Stage 4, disruption of retinal layers [16].
Statistical analysis
Continuous variables are summarized as means and standard deviations (SD). Categorical variables are reported as numbers and percentages. Statistical analysis was performed using 2-tailed Student’s t tests, Mann–Whitney U test, and chi-square tests. Statistical significance was reached at a level of P < 0.05. Analysis of variance (ANOVA) and logistic regression was performed to identify factors associated with the formation of ERM. The multivariable logistic model included covariates with P values less than 0.05 in univariable logistic regression. Odds ratio (OR) and 95% confidence intervals (95% CI) derived from logistic regression were reported. The statistical analyses were performed using SAS 9.4 software (SAS Institute Inc., Cary, NC, USA).
Results
A total of 726 eyes from 726 patients were included in this study. During a mean follow-up period of 29.7 ± 17.2 months, 32 eyes (4.41%, 95% CI: 2.9–5.9%) developed varying degrees of ERM. For all subjects, the prevalence was 3.92% (25/638) in people younger than 60 years of age, 7.59% (6/79) for people 60–69 years of age, and 11.11% (1/9) for people older than 70 years of age or older. The average age was 53.9 ± 11.1 (range 21~71) years in the ERM group and 36.6 ± 17.3 (range 18~72) years in the non-ERM group (P < 0.001). Notably, the group that developed ERM had a higher proportion of lattice degeneration than the non-ERM group (62.5% vs. 40.3%, P < 0.001). There were no significant differences between the two groups in terms of gender, BCVA, intraocular pressure, lens status, the presence of high myopia, or the use of anti-inflammatory medications after laser treatment (Table 1). The cumulative incidence of ERM in our study (4.41%, 95% CI 2.9–5.9%) was slightly lower than the five-year cumulative incidence reported in the Blue Mountains Eye Study (BMES) (5.3%, 95% CI 4.4–6.4%), in which patients did not undergo retinal laser photocoagulation or other specific treatments (Supplementary Table 1).
Table 1.
Demographics of patients who developed ERM versus those who did not after peripheral retinal laser photocoagulation.
| Characteristics | Patients without ERM | Patients developing ERM | P valued |
|---|---|---|---|
| Number of eyes | 694 | 32 | / |
| Age (years)a | 36.6 ± 17.3 | 53.9 ± 11.1 | <0.001 |
| Sex | 0.388 | ||
| Female | 347 (50.0%) | 19 (59.4%) | |
| Male | 347 (50.0%) | 13 (40.6%) | |
| BCVA (logMAR)a | 0.18 ± 0.06 | 0.20 ± 0.06 | 0.502 |
| IOP (mmHg)a | 15.5 ± 3.4 | 14.4 ± 2.9 | 0.075 |
| Pseudophakic eyes | 26 (3.74%) | 1 (3.12%) | 0.873 |
| Diagnosis | <0.001 | ||
| Lattice degeneration | 280 (40.3%) | 20 (62.5%) | |
| Other types of degenerationb | 414 (59.7%) | 12 (37.5%) | |
| High myopiac | 112 (16.1%) | 11 (34.4%) | 0.440 |
| Use of anti-inflammatory agents after laser photocoagulation (%)e | 255 (36.7%) | 7 (21.9%) | 0.087 |
aData were presented as mean ± standard deviation.
bOther types of retinal degeneration include paving stone degeneration, reticular degeneration, cystoid degeneration, and frosted branch angiitis-like degeneration.
cHigh myopia refers to a refractive error of <−6.00 dioptres or an axial length of over 26 mm.
dData were analysed using an independent samples t-test for continuous variables and for using a chi-square test for categorical variables. P values of <0.05 were considered significant.
eAnti-inflammatory agents refer to nonsteroidal anti-inflammatory eye drops, including pranoprofen, diclofenac sodium, and bromfenac sodium.
ERM epiretinal membrane, BCVA best-corrected visual acuity, logMAR Logarithm of the Minimum Angle of Resolution, IOP intraocular pressure.
To further investigate the association between laser photocoagulation and ERM formation, we reviewed a cohort of patients diagnosed with ERM confirmed by OCT, focusing on their history of laser photocoagulation. A control group without ERM from the same period was selected for comparison. The results showed that 13.1% (114/871) of patients in the ERM group had previously undergone laser photocoagulation for peripheral retinal degeneration, significantly higher than the 4.9% (53/1091) observed in the control group (P < 0.001). Interestingly, the prevalence of untreated peripheral retinal degeneration at the time of ERM diagnosis was also notably higher in the ERM group (15.3%, 116/757) compared to the control group (0.64%, 6/1038) (P < 0.001) (Table 2).
Table 2.
Comparison of the history of laser photocoagulation and the presence of retinal degeneration in eyes with and without ERM.
| Eyes with ERM | Eyes without ERM | |
|---|---|---|
| Number of eyes | 871 | 1091 |
| Previous laser treatment for retinal degeneration | 114 (13.1%) | 53 (4.9%) |
| No history of laser treatment | 757 (86.9%) | 1038 (95.1) |
| χ2 | 42.132 | |
| P value | <0.001 | |
| Untreated retinal degeneration was found at presentation | 116 (15.3%) | 6 (0.6%) |
| No retinal degeneration was found at presentation | 641 (84.7%) | 1032 (99.4%) |
| χ2 | 100.188 | |
| P value | <0.001 | |
Data were analysed using chi-square tests, and a P-value < 0.05 was considered statistically significant. “Eyes without ERM” were randomly selected from patients who visited during the same period as those with ERM and were scheduled for cataract surgery, all of whom underwent OCT examination to confirm the absence of ERM.
ERM epiretinal membranes.
The characteristics of eyes developing ERM after laser photocoagulation were summarized in Table 3. The average time between ERM formation and laser photocoagulation was 19.1 ± 17.2 (range 1~36) months. According to the Govetto grading system, 41.9% of the ERM eyes were classified as stage 1, 25.8% as stage 2, and 16.1% each as stage 3 and stage 4. During a follow-up period of 15.3 ± 10.4 months, 15 eyes (46.9%) had the ERM remained stable, while 17 eyes (53.1%) showed varying degrees of progression. Ten eyes (31.3%) underwent surgical treatment due to staging ERM advancement based on the Govetto grading system, with symptoms of blurred vision or metamorphopsia. Of these, 8 eyes demonstrated an improvement in visual acuity of more than 0.1 logMAR following surgery, while the remaining 2 eyes showed no significant improvement.
Table 3.
Characteristics of eyes developing ERM after peripheral laser photocoagulation.
| Characteristics | Number (%) |
|---|---|
| Duration from laser to ERM development (months)a | 19.1 ± 17.2 |
| Findings at first presentationERM gradingb | |
| Stage 1 | 13 (43.8%) |
| Stage 2 | 8 (25.0%) |
| Stage 3 | 5 (15.6%) |
| Stage 4 | 5 (15.6%) |
| CMT (μm)a | 232.1 ± 131.8 |
| CMO | 10 (31.3%) |
| Follow-ups | |
| Follow-up duration (months) | 15.3 ± 10.4 |
| Changes over the period | |
| Stable | 15 (46.9%) |
| Progressedc | 17 (53.1%) |
| Regressedc | 0 (0%) |
| Requirement of surgical intervention | 10 (31.3%) |
ERM epiretinal membrane, CMT central macular thickness, CMO central macular oedema, defined as a CMT greater than 250 μm.
aData were presented as mean ± standard deviation.
bERM was classified into four ERM stages according to the Govetto grading system. Stage 1 – presence of a foveal pit with well-conserved retinal layers; Stage 2 – absence of the foveal pit; Stage 3 – presence of ectopic inner foveal layers; Stage 4 – retinal layers disruption.
cProgression or regression is defined as staging advancement or regression based on the Govetto grading system, with or without a change in central macular thickness (CMT) exceeding 250 μm.
The laser parameters between the ERM and non-ERM groups were compared. As shown in Table 4, the ERM group had a greater number of laser spots compared with the non-ERM group (390.1 ± 171.9 vs. 284.4 ± 156.4, P < 0.001). In addition, the ERM group received higher values in terms of single-spot power (387.0 ± 111.2 mW vs. 308.8 ± 181.9 mW, P = 0.016) and total laser energy (22.5 ± 10.8J vs. 13.6 ± 11.9J, P < 0.001) compared to the non-ERM group. It was also found that the laser treatment in the ERM group involved an average of 4.47 ± 3.38 clock hours, which was significantly larger than the 3.08 ± 2.10 clock hours in the non-ERM group (P = 0.028). The shortest distance from the laser spots to the macular fovea was also analysed, which showed that the laser spots in the ERM group were much closer to the fovea compared to the non-ERM group (7.50 ± 1.72DD vs 8.36 ± 2.16DD, P = 0.017).
Table 4.
Laser parameters in eyes with and without ERM.
| Laser parameters | Eyes without ERM | Eyes developing ERM | P valuea |
|---|---|---|---|
| Number of laser spots | 284.8 ± 156.4 | 390.1 ± 171.9 | <0.001 |
| Single-spot power (mW) | 308.8 ± 181.9 | 387.0 ± 111.2 | 0.016 |
| Total energy (J) | 13.6 ± 11.9 | 22.5 ± 10.8 | <0.001 |
| Laser coverage (number of clock hours) | 3.08 ± 2.10 | 4.47 ± 3.38 | 0.028 |
| Location of the laser | 0.920 | ||
| Superior | 219 (31.6%) | 9 (28.1%) | |
| Nasal or temporal | 293 (42.2%) | 14 (43.8%) | |
| Inferior | 182 (26.2%) | 9 (28.1%) | |
| Multiple quadrantsb | 220 (31.7%) | 13 (40.6%) | |
| Minimum distance between the laser and the fovea (DD) | 8.36 ± 2.16 | 7.50±1.72 | 0.017 |
ERM epiretinal membranes, DD disc diameter.
aData were presented as mean ± standard deviation and were analysed using an independent samples t-test. P values of <0.05 were considered significant.
bMultiple quadrants is defined as the laser covering two or more of the retinal regions.
Binary logistic regression analysis was further performed to evaluate the independent risk factors. The results showed that the development of ERM following laser treatment was significantly associated with older age (OR, 1.071; 95%CI 1.040, 1.102; P < 0.001), a greater number of laser spots (OR, 1.003; 95%CI 1.001, 1.005; P = 0.012), and a wider laser coverage area (OR, 1.178; 95%CI 1.025, 1.354; P = 0.021) (Table 5). The area under the receiver operating characteristic curve (AUC) was 0.876, indicating moderated to strong overall predictive performance of the model.
Table 5.
Logistic regression analysis of risk factors for the development of ERM following laser photocoagulation.
| RC | SE | Wald | P* | OR value (95% CI) | |
|---|---|---|---|---|---|
| Age | 0.068 | 0.015 | 20.916 | <0.001 | 1.071 (1.040–1.102) |
| Lattice degeneration | 0.734 | 0.407 | 3.253 | 0.071 | 2.083 (0.938–4.622) |
| Number of laser spots | 0.003 | 0.001 | 6.365 | 0.012 | 1.003 (1.001–1.005) |
| Single-spot power | -0.001 | 0.001 | 0.392 | 0.531 | 0.999 (0.997–1.001) |
| Total energy | 0.033 | 0.019 | 2.924 | 0.087 | 1.033 (0.995–1.073) |
| Shortest distance between the laser and the fovea | -0.179 | 0.104 | 2.942 | 0.086 | 0.836 (0.682–1.026) |
| Laser coverage | 0.164 | 0.071 | 5.352 | 0.021 | 1.178 (1.025–1.354) |
Binary logistic regression analysis was used.
RC retrospective coefficient, SE standard error, Wald Wald coefficient, OR odds ratio, 95% CI 95% confidence interval.
*P < 0.05 was considered statistically significant.
Discussion
The association between peripheral laser photocoagulation and the risk of ERM formation remains a subject of debate. The incidence of idiopathic ERM in untreated postmortem eyes is ~5% [17], while early studies on ERM incidence following retinal photocoagulation have reported variable rates ranging from 0% to 18.2% [9–15], with one study reported a notably higher incidence (40%) [18]. The variations in incidence of ERM formation among these studies are likely attributed to the differences in nomenclature, examination methods, age of patients, follow-up duration, and patient ethnicity. In a retrospective study, Saran et al. reported an ERM incidence of 10% following laser treatment for retinal breaks and suggested that laser photocoagulation may increase the risk of ERM development [9]. It is believed that the localized inflammatory response induced by laser photocoagulation can trigger the release of cytokines and promote the proliferation and migration of glial cells, RPE, or fibroblasts on the retinal surface, thereby leading to ERM formation [7]. In addition, laser treatment may induce microstructural changes at the vitreoretinal interface, such as vitreous contraction or acceleration of posterior vitreous detachment, which is considered a key step in ERM pathogenesis [19].
However, it should be noted that most of these studies have primarily focused on patients with retinal breaks, which are considered risk factors for ERM development, as they can induce RPE exposure and pigment dispersion, vitreoretinal interface alterations, tractional forces, chronic inflammation, and compromise of the blood-retinal barrier, all of which may contribute to ERM development [20] regardless of whether treatment is administered. Those who hold this view believe that the risk factors for ERM formation are more attributable to the underlying retinal pathology rather than to the laser photocoagulation itself. Supporting this view, a long-term retrospective follow-up study demonstrated a similar incidence of ERM formation before and after retinal break laser treatment [10]. Another study reported a 2.9% incidence of ERM following laser photocoagulation in patients with retinal tears [21].
In this study, to address the difficulty of distinguishing whether ERM formation is attributable to the retinal breaks themselves or the effects of laser treatment, we specifically selected patients with peripheral retinal degeneration as the study population. This condition is typically characterized by retinal thinning or atrophy with relative preservation of the RPE, which results in minimal pigment dispersion and a less pronounced inflammatory response [22]. This selection helps potential confounding factors and allows for a more accurate evaluation of the relationship between laser photocoagulation and ERM development. It was found that during a mean follow-up of 29.7 ± 17.2 months, the incidence of ERM after laser photocoagulation was 4.41%. This rate is not higher than that reported in anatomical studies of postmortem eye and is slightly lower than the five-year cumulative incidence reported of ERM observed in the natural history cohort of the Blue Mountains Eye Study (5.3%) [23]. Our findings suggest that retinal laser photocoagulation does not significantly increase the risk of ERM development in patients with peripheral retinal degeneration.
In this study, patients who developed ERM following laser treatment were significantly older than those who did not (53.9 ± 11.1 years vs. 36.6 ± 17.3 years, P < 0.001), while there was no significant difference in sex distribution between the two groups (P = 0.388). These findings are consistent with previous studies. Age is a well-established independent risk factor for ERM, with the majority of cases occurring in individuals over the age of 50, and the prevalence peaking around 70 years of age [24–28]. The prevalence of ERM is similar between males and females, although some studies report a slightly higher rate in females [24, 26, 28–30]. Additionally, a higher proportion of patients in the ERM group exhibited lattice degeneration compared to the non-ERM group (62.5% vs. 40.3%, P < 0.001). Lattice degeneration is often associated with RPE exposure and vitreoretinal traction, which may increase the risk of ERM formation [31]. Furthermore, the proportion of patients with high myopia was greater in the ERM group than in the non-ERM group (34.4% vs. 16.1%), although this difference did not reach statistical significance (P = 0.440). Given the role inflammation-related mechanisms in the pathogenesis of ERM, the use of anti-inflammatory medications during the laser treatment period may help reduce the risk of ERM development [32]. However, in this study, the proportion of patients receiving anti-inflammatory medication was not significantly higher in the non-ERM group compared to the ERM group (36.7% vs. 21.9%, P = 0.087).
Regarding the impact of laser parameters, the ERM group received significantly higher values for the number of laser spots (390.1 ± 171.9 vs. 284.8 ± 156.4, P < 0.001), single-spot energy (387.0 ± 111.2 mW vs. 308.8 ± 181.9 mW, P = 0.016), and total energy delivered (22.5 ± 10.8J vs. 13.6 ± 11.9J, P < 0.001) compared with the non-ERM group. These findings are consistent with the hypothesis proposed by Mester et al., who suggested that extensive laser application may increase the risk of ERM formation [15]. In addition, the ERM group demonstrated a broader area of laser application (4.47 ± 3.38 clock hours vs. 3.08 ± 2.10 clock hours, P = 0.028) and a shorter minimum distance between the laser spots and the macular fovea (7.50 ± 1.70DD vs. 8.36 ± 2.01DD, P = 0.017). However, no significant difference was observed in the quadrant distribution of laser spots between the two groups (P = 0.920). To our knowledge, these specific parameters have not been previously described and may provide additional indicators for assessing the potential risks associated with laser photocoagulation. Binary logistic regression analysis identified patient age, number of laser spots, and extent of the laser coverage as significant positive indicator of ERM development following laser treatment, with regression coefficients of 0.068 (P < 0.001), 0.003 (P = 0.012), and 0.164 (P = 0.021), respectively. In contrast, single-spot energy was not significantly associated with ERM formation. It is important to note that total laser energy is inherently influenced by the number of spots, thus, including both variables in the model may introduce multicollinearity and bias the estimation of coefficient estimation. Collectively, increased patient age, a greater number of laser spots, and a wider laser treatment coverage are associated with an elevated risk of ERM formation. Therefore, when performing laser photocoagulation for peripheral retinal degeneration, minimizing the number and extent of laser spots, while ensuring complete lesion coverage—may be an effective strategy to reduce the risk of ERM.
Limitations of the present study include: (1) its retrospective design, which limits control over confounding variables and introduces the potential for loss to follow-up that may lead to an underestimation of the true incidence of ERM; (2) the lack of baseline OCT data in a small proportion of patients. Although all included patients had BCVA of ≤0.1 logMAR prior to laser treatment, the possibility of pre-existing ERM cannot be entirely excluded; (3) the timing of ERM detection was based on follow-up visits, which may not accurately reflect the true onset time; (4) age is an established independent risk factor for ERM. Due to the lack of a control group, the contribution of age to the observed ERM incidence cannot be ruled out. To address these limitations, we have initiated a prospective study incorporating multimodal imaging, including OCT, OCT angiography (OCTA), and multifocal electroretinography (mf-ERG), in order to further investigate the effects of peripheral retinal laser photocoagulation on macular structure and function.
In conclusion, this study reveals an incidence rate of 4.41% for ERM development following laser photocoagulation for peripheral retinal degeneration, suggesting that laser photocoagulation does not significantly increase the risk of ERM. Nonetheless, several factors, such as advanced age, a higher number of laser spots, and a wider laser coverage, may contribute to ERM development. Therefore, when performing laser photocoagulation for peripheral retinal degeneration, minimizing the number and extent of laser spots, while ensuring complete lesion coverage, may be an effective strategy to further reduce the risk of ERM formation.
Summary
What was known before
Due to limitations in diagnostic techniques in earlier years, reported incidences of epiretinal membrane following laser photocoagulation vary widely, ranging from 0% to 18.2%.
Diabetes, previous cataract surgery, and retinal vein occlusion are risk factors for epiretinal membrane development
What this study adds
Using OCT imaging, we observed an incidence rate of 4.41% for ERM development following laser photocoagulation for peripheral retinal degeneration, suggesting that laser does not significantly increase the risk of ERM
Older age, a higher number of laser spots, and a wider laser coverage, contribute to ERM development after laser photocoagulation.
Supplementary information
Author contributions
Conception of the work (Z Huang); Acquisition, analysis, and interpretation of data for the work (B Xie, Y Lin, C Lin, X Qiu, and D Zheng); Drafting the work (B Xie); Revising the work critically for important intellectual content (Z Huang); supervision (D Huang, W Chen, and Z Huang); Final approval of the version to be published (all authors).
Funding
This study was supported by the Funding from the Shantou Science and Technology Plan Project (No. 221113086496943), and the Special Support Plan in Guangdong Province for Young Top Talents in Science and Technology Innovation
Data availability
All of the data and materials will be available upon request to the corresponding author.
Competing interests
The authors declare no competing interests.
Ethics approval
This retrospective study was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Human Investigation Committee (IRB) of Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong approved this study. The study was deemed exempt from informed consent due to its retrospective design.
Footnotes
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
The online version contains supplementary material available at 10.1038/s41433-025-03945-5.
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