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

(See Figure 11.26.1.)

Figure 11.26.1: Epiretinal membrane with pseudohole.

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).

• 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.

• 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 VH.

• Uveitis. See Chapter 12, Uveitis.

• Retinal dystrophies. See 11.28, Retinitis Pigmentosa and Inherited Chorioretinal Dystrophies.

• Intraocular tumors.

• Other retinal vascular disease (diabetic retinopathy, vein occlusion, etc.).

1. History: Previous eye surgery or eye disease? Diabetes?

2. Complete ocular examination, particularly a thorough dilated fundus evaluation and careful  macula evaluation with a slit lamp and a handheld lens. A careful peripheral examination should be performed to rule out a retinal break.

3. OCT can show a hyperreflective layer over the surface of the retina, loss of foveal depression, and intraretinal cysts (See Figure 11.26.2).

   Figure 11.26.2: Optical coherence tomography of epiretinal membrane.

   

1. Treat the underlying disorder.

2. PPV with membrane peel can be considered when it significantly reduces vision.

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.