CASE REPORT


65-year-old woman came to a medical Centre in March 2013 with symptoms of blurred vision in her left eye. She had a history of branch retinal vein occlusion in the left eye in January 2012 and 2 sessions of retinal laser photocoagulation in the upper quadrants.


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Epiretinal Membrane

On examination, the best corrected visual acuity (BCVA) was 0.7 in the left eye. The lens was clear and the fundus examination showed pigment atrophy and retinal wrinkling in the macular area, occlusion of the upper-temporal branch of the central retinal vein, traces of laser photocoagulation in the upper quadrants, and peripheral retinal neovascularization with focal vitreous hemorrhages.

Optical coherence tomography (OCT) revealed incomplete posterior vitreous detachment, ERM on the macular surface, and slight diffuse retinal edema. The diagnosis was Epiretinal Membrane (ERM).

Epiretinal Membrane DISEASE entity


Epiretinal Membrane (ERM) is a fibrocellular tissue found on the inner surface of the retina. It is semi-translucent and proliferates on the surface of the internal limiting membrane.

Epiretinal Membrane

Idiopathic ERMs are the most common presentation. Secondary ERMs occur in association with retinal vascular diseases including diabetic retinopathy, retinal vein occlusion, ocular inflammatory disease, trauma, intraocular surgery, intraocular tumors, and retinal tear or detachment.

Other risk factors include age, posterior vitreous detachment, and history of Epiretinal Membrane (ERM) in the fellow eye.

The mean age of ERM diagnosis is 65 years old. The incidence of developing an ERM in the primary eye is 1.1% per year. The incidence of developing an ERM in the fellow eye is 2.7% per year.

Retinal glial and retinal pigment epithelial cells are the major components. Fibrous astrocytes, fibrocytes, myofibrocytes, and macrophages can also be identified in the pathological analysis.

Epiretinal Membrane Diagnosis 


A clinical diagnosis is based on history and clinical exam, including slit lamp and dilated fundus examination. In some cases, Optical Coherence Tomography (OCT) is useful in the diagnosis, quantification of retinal thickness, and management of this condition.

Epiretinal Membrane

MANAGEMENT of Epiretinal Membrane


General treatment

The most important issue in the management of idiopathic ERMs is the presence of visual complaints. Visual symptoms can be variable and sometimes independent of clinical severity.

Surgery

Epiretinal Membrane (ERM) surgery is the most common vitreoretinal surgery performed as reported by the Centers for Medicare and Medicaid Services.

Surgery involves a pars plana vitrectomy procedure with membrane peel. A number of different instruments can be used to facilitate removal including intraocular forceps, pick, diamond dusted instruments, as well as other instruments.

In many cases, internal limiting membrane peel is also performed concurrently with Epiretinal Membrane (ERM) removal.

Surgical follow-up

Surgery is indicated if the patient has significant visual complaints of visual decline and /or metamorphopsia.

The follow-up is similar for most eyes following pars plana vitrectomy surgery. Visual acuity improvement does not occur immediately in some patients.

This is highly dependent on preoperative characteristics, duration of the Epiretinal Membrane, as well as other factors. Most patients improve by 3-6 months postoperatively. However, some may experience improvement 1-2 years postoperatively.

Would you have interest in taking retinal images with your smartphone?

Fundus photography is superior to fundus analysis as it enables intraocular pathologies to be photo-captured and encrypted information to be shared with colleagues and patients.

Recent technologies allow smartphone-based attachments and integrated lens adaptors to transform the smartphone into a portable fundus camera and Retinal imaging by smartphone.

RETINAL IMAGING BY YOUR SMARTPHONE

REFERENCES


  1.  Fraser-Bell S, Guzowski M, Rochtchina E, et al. Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains Eye Study. Ophthalmology 2003;110(1):34-40. 
  2.  Gillis K. Medicare Physician Payment Schedule Services for 2001 – A Summary of Claims Data. In: Physician Marketplace Report. Chicago: American Medical Association, 2003.
  3.  Gupta OP, Brown GC, Brown MM. A value-based medicine cost-utility analysis of idiopathic epiretinal membrane surgery. Am J Ophthalmol 2008;145(5):923-8.

RETINAL IMAGING BY YOUR SMARTPHONE

RETINAL IMAGING BY YOUR SMARTPHONE

RETINAL IMAGING BY YOUR SMARTPHONE

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