Epiretinal Membrane
SALIENT FEATURES
Epiretinal membrane (ERM), also termed “macular pucker,” is a common condition that arises from fibrocellular proliferation at the vitreoretinal interface.1
ERM is most commonly idiopathic and associated with aging. Secondary causes include retinal vascular disease, uveitis, retinal detachment, or iatrogenic from laser or surgical intervention.2
Clinical presentation can vary from asymptomatic to complaints of visual distortion, metamorphopsia, and loss of central vision.
On examination, early ERMs appear as a cellophane sheen with blunted foveal reflex. In advanced cases, the ERM appears as preretinal fibrosis and causes retinal distortion and tractional folds.1
The majority of ERMs are nonprogressive and asymptomatic and thus can be observed.
Management of visually significant epiretinal membranes is surgical and involves pars plana vitrectomy with ERM peeling. Concurrent internal limiting membrane peeling is often performed to decrease the risk of ERM recurrence.3
OCT IMAGING
Optical coherence tomography (OCT) is the diagnostic imaging test of choice to assess epiretinal membranes, which appear as a hyperreflective band on the retinal surface4 (Figure 32.1).
Several OCT-based ERM classification systems have been proposed and take into account clinically relevant anatomic changes that occur
as a result of membrane contracture. One scheme includes the following four stages5:
FIGURE 32.1 A, Optical coherence tomography (OCT) showing an epiretinal membrane (red arrow) causing traction on the retina with loss of the foveal contour. B, OCT of the same patient 1 year later showing progression of the epiretinal membrane. There is disruption of the inner retinal layers and ectopic inner foveal layers present (red star).
Stage 1: Presence of foveal pit with well-defined retinal layers
Stage 2: Absence of foveal pit with well-defined retinal layers
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