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 Table of Contents    
CLINICAL IMAGE
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 56-57  

Spontaneous epiretinal membrane separation


Department of Ophthalmology, University of California-San Francisco, San Francisco, California, USA

Date of Web Publication15-May-2013

Correspondence Address:
Daniel M Schwartz
Department of Ophthalmology, Vitreoretinal Service, 10 Koret Way, Room K219, San Francisco, California 94143-0730
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-620X.111921

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How to cite this article:
Kolomeyer AM, Schwartz DM. Spontaneous epiretinal membrane separation. Oman J Ophthalmol 2013;6:56-7

How to cite this URL:
Kolomeyer AM, Schwartz DM. Spontaneous epiretinal membrane separation. Oman J Ophthalmol [serial online] 2013 [cited 2019 Dec 7];6:56-7. Available from: http://www.ojoonline.org/text.asp?2013/6/1/56/111921


   Introduction Top


Idiopathic epiretinal membranes (ERM) occur mainly in patients above 50 years of age, and are bilateral in up to 20% of cases. [1] ERM undergoes spontaneous separation most commonly in young subjects, women, and myopes; it occurs in approximately 1-3% of cases overall, and generally results in visual improvement. [2],[3],[4],[5] Several retinal diseases and mechanisms resulting in spontaneous ERM separation have been described. [6] It has been noted to occur in patients with Toxoplasmic retinochoroiditis, Stargardt macular dystrophy, and Leber's multiple military aneurysms, and has been associated with trauma and laser treatment. [6],[7],[8],[9] Here, we present spectral-domain optical coherence tomography (SD-OCT) images documenting sequential spontaneous ERM separation.


   Case Report Top


A 68-year-old woman presented with 1-2 months of decreasing vision in her right eye. Past ocular history included bilateral radial keratotomy 16 years prior. Visual acuity (VA) was 20/60 in the right eye and 20/30 in the left eye. Anterior segment evaluation and intraocular pressures were normal. Metamorphopsia was present on Amsler grid. Posterior vitreous detachments (PVD) were noted bilaterally. SD-OCT showed an ERM bilaterally [right eye shown in [Figure 1]a. We decided to observe the patient without surgery. Left eye VA and ERM remained stable throughout subsequent examinations. At 4 months, VA in the right eye was unchanged. SD-OCT showed spontaneous ERM separation temporal to the fovea where it remained attached [Figure 1]b. At 7 months, VA was 20/60 in the right eye. SD-OCT showed further separation of the ERM from the fovea [Figure 1]c. At 12 months, best-corrected VA was 20/40 in the right eye. SD-OCT showed a lamellar hole with continued separation of the ERM crossing the fovea and remaining attached nasal to the fovea [Figure 1]d.
Figure 1: (a) At presentation. Epiretinal membrane (ERM) is fully attached at and nasal to the fovea, (b) 4 months later. ERM scrolled-up (white star) and separated temporal to the fovea. ERM is still attached at the fovea, (c) 6 months later. ERM scrolled-up edge (white star) continues to separate. It now appears detached from the fovea. ERM created a pseudohole and pulled up the retina temporal to the fovea, (d) 12 months later. ERM has fully separated from the fovea and is now separating nasal to the fovea (white star). Perifoveal cystoid change is present (white arrows)

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Comment

Surgical removal of ERM results in visual improvement in 75-85% of eyes. [10],[11] Conservative treatment of our patient obviated the need for surgery because the ERM spontaneously peeled across the fovea. This process may have been associated with PVD observed in our patient, and supports previous similar observations. [12],[13] Non-surgical approach has been previously shown in the literature to result in improved vision in select circumstances. [4],[8],[14] Vision improved from 20/60 to 20/40 in our patient.

While ERM are known to spontaneously peel, this is a rare event and should not influence decision for surgical intervention. Conversely, monitoring spontaneous ERM peel on SD-OCT may defer surgical intervention and indicate observation for further relief of traction on the fovea.

 
   References Top

1.Pearlstone AD. The incidence of idiopathic preretinal macular gliosis. Ann Ophthalmol 1985;17:378-80.  Back to cited text no. 1
    
2.Byer NE. Spontaneous disappearance of early postoperative preretinal retraction. A sequel of retinal detachment surgery. Arch Ophthalmol 1973;90:133-5.  Back to cited text no. 2
    
3.Sachdev N, Gupta V, Gupta A, Singh R. Spontaneous separation of idiopathic epiretinal membrane in a young patient. Int Ophthalmol 2008;28:301-2.  Back to cited text no. 3
    
4.Meyer CH, Rodrigues EB, Mennel S, Schmidt JC, Kroll P. Spontaneous separation of epiretinal membrane in young subjects: Personal observations and review of the literature. Graefes Arch Clin Exp Ophthalmol 2004;242:977-85.  Back to cited text no. 4
    
5.Desatnik H, Treister G, Moisseiev J. Spontaneous separation of an idiopathic macular pucker in a young girl. Am J Ophthalmol 1999;127:729-31.  Back to cited text no. 5
    
6.Sumers KD, Jampol LM, Goldberg MF, Huamonte FU. Spontaneous separation of epiretinal membranes. Arch Ophthalmol 1980;98:318-20.  Back to cited text no. 6
    
7.Gupta A, Gopal L, Biswas J. Spontaneous separation of inflammatory epiretinal membrane in a patient with toxoplasmic retinochoroiditis. Oman J Ophthalmol 2012;5:64-5.  Back to cited text no. 7
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8.Cakir M, Cekiç O, Bayraktar S, Yilmaz OF. Spontaneous separation of epiretinal membrane in a child with Stargardt macular dystrophy. J AAPOS 2007;11:618-9.  Back to cited text no. 8
    
9.Murata T, Koga H, Fujita H, Noguchi R, Miura M, Kimura J. Spontaneous separation of thick epiretinal membrane after photocoagulation for Leber's multiple miliary aneurysms. Jpn J Ophthalmol 2007;51:78-9.  Back to cited text no. 9
    
10.Poliner LS, Olk RJ, Grand MG, Escoffery RF, Okun E, Boniuk I. Surgical management of premacular fibroplasia. Arch Ophthalmol 1988;106:761-4.  Back to cited text no. 10
    
11.Donati G, Kapetanios AD, Pournaras CJ. Complications of surgery for epiretinal membranes. Graefes Arch Clin Exp Ophthalmol 1998;236:739-46.  Back to cited text no. 11
    
12.Greven CM, Slusher MM, Weaver RG. Epiretinal membrane release and posterior vitreous detachment. Ophthalmology 1988;95:902-5.  Back to cited text no. 12
    
13.Shirakawa H, Ogino N. Idiopathic epiretinal membranes with spontaneous posterior vitreous separation. Ophthalmologica 1987;194:90-4.  Back to cited text no. 13
    
14.Gao H, Salam GA, Chern S. Spontaneous separation of idiopathic epiretinal membrane in a 7-year-old child. J AAPOS 2007;11:393-4.  Back to cited text no. 14
    


    Figures

  [Figure 1]


This article has been cited by
1 CHARACTERISTICS OF SPONTANEOUS IDIOPATHIC EPIRETINAL MEMBRANE SEPARATION IN SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY
Hyun S. Yang,Ji W. Hong,Yoon J. Kim,June-Gone Kim,Soo G. Joe
Retina. 2014; 34(10): 2079
[Pubmed] | [DOI]



 

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