Epiretinal Membrane (ERM)

Question 1

What is an ERM and what may the px develop as a result?

Answer 1

• Fairly common
• Fibrocellular film that develops on retinal surface
• Contraction of membrane causes wrinkling of surface

Question 2

What may a px develop as a result of having an ERM?

Answer 2

o Loss of foveal contour
o Irregular retinal surface
o Pseudocyst – looks like fluid at macula, but is not – just where retinal architecture/anatomy has been distorted, pulls layers apart
o CMO formation

Question 3

Symptoms of ERM?

Answer 3

• Most ERM are completely asymptomatic & require no treatment
• Most ERM are composed of glial tissue growing on surface of retina following PVD
  o Cellophane maculopathy
  o Pre-macular fibrosis
• This contracts leading to wrinkling and thickening of retina
  o Retina may also distort and thicken
• Retinal distortion causes metamorphopsia and blurred vision
• Reduced VA
• Distortion
• Asymptomatic
• ONLY REFER IF PATIENT IS TRULY SYMPTOMATIC of disease

Question 4

Signs of ERM?

Answer 4

• Reflective layer on surface of retina – shiny appearance
• Clinically significant ERM will have contracted, causing retinal folds, & distortion of the retinal BVs
• Distortion of retinal BVs:
  o Vessels straightened
  o Vessels wrinkled
• Membrane itself may be difficult to see, except if there is an elevated edge – there will be a clearly visible white or grey pre-retinal membrane
• ONLY REFER IF PATIENT IS TRULY SYMPTOMATIC of disease

Question 5

ERM causes?

Answer 5

• PVD:
  o Commonly associated with ERM
  o Damage to ILM allowing glial proliferation on retinal surface
• Retinal Breaks/RD:
  o RPE cells are shed through break & proliferate on surface of macula
• Retinal Vascular Disease:
  o Retinal branch vein occlusion
  o Diabetic Retinopathy
• Unknown/Idiopathic
• Inflammation – uveitis
• Infection
• Post-op
• Post-laser
• Vascular disease – diabetic maculopathy, retinal vein occlusion
• Initially identify if any other cause & treat the cause rather than epiretinal membrane to begin with
• Epiretinal membrane will not go away even if treat other causes – however once root cause is treated, the px may longer be symptomatic and bothered by epiretinal membrane