Epiretinal Membrane – September, 2024
History:
A 54-year-old presented with progressive blurry vision in the right eye (OD) two months following barricade laser for a retinal detachment in this eye.
Exam:
Visual acuity (VA) was 20/150 OD and 20/20 in left eye (OS). Intraocular pressure (IOP) was normal in both eyes (OU) and anterior segment exam revealed 1+ nuclear sclerosis OU. Dilated fundus exam OD revealed a PVD with mild vitreous hemorrhage, epiretinal membrane (ERM) over the macula (Figure 1), and a localized retinal detachment with retinal tear at 11:30 surrounded by laser barricade. Dilated fundus exam OS was unremarkable.
At the time of the retinal detachment laser barricade two months prior VA was 20/20 and OCT showed no ERM (Figure 2).
The patient underwent a pars plana vitrectomy with ERM and inner limiting membrane peel. Six months later the patient was doing well with VA of 20/25 and markedly improved retinal architecture (Figure 3).
Discussion:
Epiretinal Membrane
Epiretinal membrane, or macular pucker, is a disorder due to fibrocellular tissue proliferation on the surface of the retina. This proliferation causes distortion of normal retinal architecture often manifesting symptomatically as metamorphopsia, decreased visual acuity, micropsia, or monocular diplopia. ERM is best diagnosed through clinical exam and OCT.
While 95% of ERMs are thought to be idiopathic, secondary ERMs can result following retinal tear, retinal detachment, ocular inflammation, trauma, prior surgery, or retinal vascular disease. While idiopathic ERMs typically have a slowly evolving clinical course, secondary ERMs in some cases progress acutely and may represent an early stage of proliferative vitreoretinopathy.
Surgery is the treatment of choice for ERMs. During surgery the ERM is peeled off the surface of the retina allowing the retinal tissue to lie flat. Often times the ILM is peeled away as well, since this layer may act as a scaffold for the ERM to proliferate, thereby reducing the likelihood of ERM recurrence. The healing process often takes 4-6 months but improvement can be seen at even longer intervals.
If you are looking to schedule your first consultation, please contact us today by clicking HERE and find the location that is nearest you!
References:
- Kanukollu VM, Agarwal P. Epiretinal Membrane. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560703/
- Ueki M, Morishita S, Kohmoto R, Fukumoto M, Suzuki H, Sato T, Kobayashi T, Kida T, Oku H, Ikeda T, Shibayama Y. Comparison of histopathological findings between idiopathic and secondary epiretinal membranes. Int Ophthalmol. 2016 Oct;36(5):713-8. doi: 10.1007/s10792-016-0194-7. Epub 2016 Feb 8. PMID: 26857724.
- Sella R, Sternfeld A, Budnik I, Axer-Siegel R, Ehrlich R. Epiretinal membrane following pars plana vitrectomy for rhegmatogenous retinal detachment repair. Int J Ophthalmol. 2019 Dec 18;12(12):1872-1877. doi: 10.18240/ijo.2019.12.09. PMID: 31850171; PMCID: PMC6901877.