To follow the long-term course of visual acuity (VA) and central retinal thickness (CRT) over at least a 3-year follow-up after vitreous surgery in patients with epiretinal membrane (ERM). This study examined 43 eyes of patients who underwent 23- or 25-gauge vitreous surgery for ERM. There was significant improvement of the VA at 3 months after surgery compared with baseline, with the improvements maintained for 5 years (analysis of variance [ANOVA]; P < .05). There was a significant decrease in the mean CRT from 1 month up to 5 years (ANOVA; P < .05). There was also a significantly worse mean VA found for cases exhibiting an outer retinal layer disorder before surgery. Disorders of the outer layer of the retina before surgery have an influence on the VA outcome, with changes sometimes occurring even after the long-term postoperative follow-ups. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e105-e111.].