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Prophylactic treatment of lattice degeneration with laser photocoagulation remains controversial. We evaluated whether prophylactic laser for lattice degeneration increases epiretinal membrane (ERM) risk. In a retrospective cohort (2005–2025), patients receiving laser within 90 days of lattice diagnosis were classified as exposed; untreated patients served as controls and were matched 3:1. ERM within 10 years was analysed using Fine–Gray competing-risk models (death as competing event). ERM occurred in 38/321 (11.8%) laser-treated versus 53/944 (5.6%) untreated patients (sHR=2.50, 95% CI 1.65 to 3.79; p<0.001). Prophylactic laser was associated with higher ERM risk, warranting careful consideration of its risk–benefit profile.