Dexamethasone Intravitreal Implant as an Adjunct to Vitrectomy with Epiretinal Membrane Peeling: A Review of the Literature

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.