Patient has spontaneous separation of epitretinal membrane

Photojournalism
Ophthalmology Times
May 15, 1999

A 40-year-old man presented with complaints of slight decrease of vision OS with associated metamorphopsia. The patient described a “ghost-like” image and halos around lights for 3 weeks and had a history of amblyopia OD. Visual acuity was 20/400 OD and 20/15 OS, and Amsler grid testing showed distortion superiorly and nasal to fixation OS.

The dilated examination revealed a grade zero mild epiretinal membrane in the Papillomacular bundle with a few faint striae extending from the fovea out temporally. Fluorescein angiography performed to evaluate the patient’s complaints further showed only mild striae in the macula with no window defect and no late dye stainage. Combined with the patient’s good visual acuity, observation was recommended.

Two weeks after the initial visit, the patient presented with complaints of sudden onset of flashes and floater OS for 3 days. The patient noted a single large circular floater in his central vision OS and commented that the metamorphopsia he had experienced was now gone.

The dilated examination showed a complete posterior vitreous detachment OS. The macular striae noted previously were now resolved, and the cellophane epiretinal membrane was now adjacent to a Weiss ring on the posterior hyaloid surface.

Discussion

 Spontaneous total separation of an epiretinal membrane is not common. Donald Gass, MD, described a partial separation of an epitretinal membrane that often stops along the course of a major vessel, where the vitroretinal adhesion may be maximum. In another case, he observed the epiretinal membrane detaching from the entire macular surface and remaining as an adherent mass in the extramacular region.1

 Sumers, et al. described three cases of spontaneous epiretinal membrane separation in 1980.2  Interestingly, two of the patients had previous argon laser photocoagulation of peripheral retinal lesions. The article reports that it is possible that vitreous contraction, which had led to the fundus conditions that required the laser treatment, may have affected the vitreous or the membrane, which in turn enhanced the separation of the membrane.

 The article goes on to state that although laser photocoagulation near macular puckers may make them worse,3 the presence of an epiretinal membrane should not be considered a contraindication to photocoagulation of the lesion to be treated has a worse prognosis if left untreated.

 Spontaneous “peeling” or separation of epiretinal membranes is uncommon and may result in resolution of macular traction and improved visual acuity.

 References

Gass JD. Stereoscopic atlas of macular diseases, diagnosis and treatment.
Mosby –Year Book Inc. 1997; 12:946

Sumers KD, Jampol LM, Goldber MF, Huamonte FU. Spontaneous separation of epiretinal membranes. Archives of Ophthalmology 1980;98:318-320

Cibis PA. Vitreoretinal pathology and surgery in retinal detachment.
St. Louis: CV Mosby Inc., 1965:33