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Purpose: To describe the 2-year functional and anatomical outcomes in patients operated on for combined cataract and idiopathic epiretinal membrane (ERM) and to study the relationship between best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) throughout the follow-up. Methods: This retrospective observational case series included 72 eyes operated on for combined cataract and idiopathic ERM. They were followed with clinical and SD-OCT examinations preoperatively and 1, 6, 12, and 24 months after surgery. Foveolar thickness (FT), photoreceptor status and morphological parameters were assessed. Results: BCVA and FT substantially improved at 24 months. Postoperatively, no significant improvement was observed beyond 6 months for BCVA and 12 months for FT. Outer limiting membrane and inner and outer segment junction disruption scores were well correlated with BCVA both pre- and postoperatively, and significant visual improvement was demonstrated in each subgroup except in those with the highest scores. FT was correlated with BCVA only from 6 to 24 months postoperatively. Conclusion: After combined cataract and idiopathic ERM surgery, BCVA and FT improved rapidly. Most functional and anatomical recovery took place within the first 6 months, but this did not preclude late improvement, in particular in patients with the most disorganized photoreceptor layers. At each time point, the amount of photoreceptor damage seemed closely correlated with visual acuity, but concerning FT, this relationship remains questionable.