Epiretinal Membrane (Macular Pucker, Surface-Wrinkling Retinopathy, Cellophane Maculopathy)

Most are asymptomatic; can have decreased or distorted vision or both. Incidence increases with age. Twenty percent bilateral, though often asymmetric.

Signs ⬆ ⬇

(See Figure 11.26.1.)

Critical

Spectrum ranges from a fine, glistening membrane (cellophane maculopathy) to a thick, gray-white membrane (macular pucker) present on the surface of the retina in the macular area.

Other

Retinal folds radiating out from the membrane; displacement, straightening, or tortuosity of the macular retinal vessels; ME or macular detachment. A ring-shaped condensation of the ERM around the fovea may simulate a macular hole (pseudohole).

11-26.1 Epiretinal membrane with pseudohole.

Differential Diagnosis ⬆ ⬇

Diabetic retinopathy: May produce preretinal fibrovascular tissue, which may displace retinal vessels or detach the macula. ME may be present. See 11.12, DIABETIC RETINOPATHY.
CME. See 11.14, CYSTOID MACULAR EDEMA.

Etiology ⬆ ⬇

PVD. See 11.1, POSTERIOR VITREOUS DETACHMENT.
Retinal break, RRD. A higher risk of ERM for PVD patients who also have a tear or RRD versus PVD alone. See 11.2, RETINAL BREAK and 11.3, RETINAL DETACHMENT.
Idiopathic. ERM can occur without obvious cause and has been seen in very young children.
After retinal cryotherapy or photocoagulation.
After intraocular surgery, trauma, or vitreous hemorrhage.
Uveitis.See Chapter 12, UVEITIS.
Other retinal vascular disease (diabetic retinopathy, vein occlusion, etc.).

Work Up ⬆ ⬇

Workup

History: Previous eye surgery or eye disease? Diabetes?
Complete ocular examination, particularly a thorough dilated fundus evaluation and careful macula evaluation with a slit lamp and a 60- or 90-diopter, Hruby, or fundus contact lens. A careful peripheral examination should be performed to rule out a retinal break.
OCT is helpful in evaluating ERMs (see Figure 11.26.2).

11-26.2 Optical coherence tomography of epiretinal membrane.

Treatment ⬆ ⬇

Treat the underlying disorder.
Examine the periphery to rule out a retinal break.
Surgical peeling of the membrane can be considered when it significantly reduces the vision.

Follow Up ⬆

This is not an emergent condition, and treatment may be instituted at any time. Often does not progress over time. A small percentage of ERMs recur after surgical removal.