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. 2019 Dec 13;9:19056. doi: 10.1038/s41598-019-55544-6

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© The Author(s) 2019

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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A hypothetical mechanism for the differences related to the tractional force of the retina according to the axial length (AL). (a) Eyes with a shorter AL may have undetached or incompletely detached posterior vitreous, which directly mediates vitreous tractional force to the macula chronically (arrows). Under this condition, idiopathic epiretinal membrane (iERM) modification by glial cells and cytokines may occur easily; this further strengthens the adhesion of iERM to the retina and increases the tractional force. In addition, the surgical procedure to intentionally detach the vitreous and/or iERM may mediate greater tractional force to the retina acutely, which induces more damage to the macula. (b) In contrast, eyes with relatively longer AL may already have posterior vitreous detachment or vitreous schisis (shaded area), which causes less traction (arrows) and less damage to the macula. iERM is shown in green.