Puckered!

Epiretinal Membrane ⁣

An avascular fibrocellular membrane that proliferates on the inner surface of the⁣

retina and produces visual impairment⁣

Causes:⁣

Idiopathic ERMs is the most common presentation. ⁣

Secondary ERMs: retinal vascular diseases including diabetic retinopathy, retinal vein occlusion, ocular inflammatory disease, trauma, intraocular surgery, intraocular tumors, and retinal tear or detachment.⁣

Symptoms: Gradual painless loss of vision, Metamorphopsia, Micropsia⁣

Pathology: Fibrous proliferative membrane like structure consisting of cells interspersed with an extracellular matrix.⁣

Fundus examination: ⁣

Thin sheen like membrane to a thick opaque membrane, associated with vascular tortuosity, straightening and dragging of vessel toward the fovea. ⁣

Associated intraretinal hemorrhage, cystic changes in macula, cotton wool spots, macular edema, macular hole or pseudohole. ⁣




Gass classification of ERM :⁣

Grade 0 – Cellophane maculopathy⁣

● Completely translucent membrane barely visible clinically. There is no foveal distortion and retinal traction ⁣

Grade 1 – Crippled cellophane maculopathy⁣

● Contraction of ERM⁣

● Membrane causes an irregular wrinkling of inner retinal surface.⁣

● If wrinkling is severe enough, para macular vessels may be pulled towards the fovea⁣

in a corkscrew formation (seen on FFA) ⁣

Grade 2 – Macular pucker⁣

● Membrane is thick and opaque.⁣

● Full thickness puckering of macula may be present along with edema, small⁣

hemorrhages, cotton wool spots and sometimes localized RD⁣

● Severe visual loss⁣

Cause of vision loss in ERM:⁣

● Contraction of ERM causes elevation of macula⁣

● Retinal distortion and traction⁣

● Macular edema⁣

Investigations :⁣

● Amsler grid⁣

● FFA - can show retinal vascular tortuosity, straightening and leakage, as well as⁣

CME, also helps in excluding the other retinal pathologies that may cause ERM formation ⁣

● OCT- To see CME,VMT,Localizing the edge and thickest part of ERM and to⁣

differentiate lamellar macular hole from pseudohole⁣

● Multifocal ERG⁣

Management :⁣

● ERM removal with/without ILM peeling


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