2. Epiretinal membrane (ERM)
An avascular
fibrocellular membrane
that proliferates on the
inner surface of the retina
to produce various
degrees of macular
dysfunction
7. Epidemiology and pathogenesis
Secondary
After repair of RRD : 4-8%
–Risks : older age, preop VH, macular
detachment, preop sign of PVR, large
RB, use of cryo, multiple Sx
–RPE cells that liberated into the vit
cavity and proliferate
9. Ocular manifestations
Depend on its
thickness and the extent
(occlusion) to which it has undergone
shrinkage or contraction (traction)
10. Ocular manifestations:
thin ERM, Cellophane maculopathy
thin and transparent
Abnormal glistening light reflex from the inner
retinal surface
Mostly asymptomatic
11. Ocular manifestation:
thick ERM, pucker
Inner retinal striae radaite from edge of ERM
White-gray/ white translucent membrane, may
obscure visualization of the retinal vessels
12. Ocular manifestation: thick ERM
More severe degree of macular dysfunction
Macular distortion, folding, puckering
Macular edema, pre-retinal/ intraretinal
hemorrhage
Foveal ectopia, macular pseudohole
TRD, RB, RRD
14. Ocular manifestation: thick ERM
Vision loss
Metamorphopsia
central photopsia
binocular diplopia
macropsia
15. Ocular manifestation :
pseudo or true macular hole
Pseudohole
Wrinkle of inner retinal surface
Retinal tissue at the base of pseudohole
Absence of characteristics of true hole: yellow
pigment deposits in the base, halo of neural
detachment. Overlying operculum/ pseudooperculum
Equivocal cases : OCT, FFA
17. Diagnosis and ancillary testing
Clinical, based on biomicroscopic observation
Examination/ photography with Red-free light
Watzke-Allen test
OCT
FFA: retinal vascular distortion that underlies an
ERM
20. DDX
VMT syndrome
Combined RPE and retinal hamartoma
Prominent macular light reflex in the young
CME
Optic disc swelling (juxtapapillary ERM)
Idiopathic MH
21. Pathology
ERM consists of avascular
fibrocellular sheet
Native vitreous
Newly synthetic collagen
Fragment of ILM
Myofibroblastic Cells : RPE cells, fibrous
astrocytes, macrophages
22. Treatment
ERM with minimal symtoms : no treatment but
observation
Treat in cases of
Significant visual loss
Metamorphopsia
Intolerable binocular diplopia
23. Goal of treatment
Reduce or eliminate most common
mechanisms of visual loss, including macular
distortion, TRD, foveal ectopia, membrane that
cover the fovea, retinal vascular leakage with
macular edema, traction-induce obstruction of
axoplasmic fold
24. Surgical procedures
Pars plana vitrectomy
+/- staining
Engage the edge of
ERM with a retinal
pick/ forceps/ sharp
bent-tip needle
Peel the membrane
with forceps
28. Course and outcomes
Most pts who have ERM experience little or
no symptom progression after dx
10-25% of eyes show a decline in VA in
mths/ yrs
Rarely spontaneous separate from retina
29. Course and outcomes
After Sx, resolute within days/ wks
VA improve 2 or more snellen lines in 60-
85% of eyes and may continue for 6-12
mths after Sx
2-15% of eyes have worse VA postop
Visual function rarely returns to normal
30. Cases with minimal benefit
Patients who have symptoms that has
lasted longer than 1 yr
Findings that suggest long-standing cases
Atrophic/ hypertrophic RPE alterations
Intraretinal lipid/ hard exudates
Microvascular changes such as
microaneurysms
