J Korean Ophthalmol Soc.  2016 Apr;57(4):682-685. 10.3341/jkos.2016.57.4.682.

Reproliferation of Idiopathic Epiretinal Membrane after Spontaneous Separation

• Kwon JM
• Lee JH
• Kim KH
• Park SW
• Lee JE
• Byon IS

• KMID: 2212807
• DOI: http://doi.org/10.3341/jkos.2016.57.4.682

Abstract

PURPOSE
To report the reproliferation of membrane after a spontaneous separation in a patient with idiopathic epiretinal membrane (ERM).
CASE SUMMARY
A 62-year-old woman complained of metamorphopsia in the left eye. Her vision without correction was 0.8. On fundus examination, the epiretinal membrane was covering the fovea with posterior vitreous detachment. Optical coherence tomography (OCT) showed the ERM and thickened macula. Retinal break, intraocular inflammatory disease, and retinal vascular disease were not noted. We diagnosed her with idiopathic ERM and followed up regularly. At month 7, a partial separation of the membrane from the retinal surface was noted. At month 12, complete spontaneous separation of the ERM from the macula except that in the temporal area was accompanied by improvement of vision to 1.0. OCT, showing recovery of the fovea contour. However, her corrected vision decreased to 0.7 at month 17, and the ERM was again observed to cover the macula. Thickening of the ERM progressed further, and her corrected vision decreased to 0.5 at month 21.
CONCLUSIONS
Spontaneous separation of membrane is a rare phenomenon in idiopathic ERM. Reproliferation of membrane can develop and induce visual impairment. Therefore, regular examination is recommended in patients with spontaneous separation of membrane.

Keyword

Idiopathic epiretinal membrane; Metamorphopsia

MeSH Terms

Epiretinal Membrane*
Female
Humans
Membranes
Middle Aged
Retinal Perforations
Retinaldehyde
Tomography, Optical Coherence
Vascular Diseases
Vision Disorders
Vitreous Detachment
Retinaldehyde

Figure

• 

  Figure 1. Fundus photograph and optical coherence tomography (OCT) images during the follow-up period. (A) Baseline fundus photograph demonstrates the opaque epiretinal membrane (ERM) covering the fovea. Thickened macula and retinal folding were detected in the baseline OCT images. The central macular thickness was 439 μm. The best corrected visual acuity (BCVA) was 0.8. (B) At 12 months, the ERM was spontaneously separated from the retina. OCT scan shows a scrolled edge of the membrane (arrows) and foveal contour recovery. The macular thickness decreased to 367 μm. BCVA improved to 1.0. (C) At 21 months, reproliferative ERM covered the macula. The macular thickness increased to 469 μm. BCVA decreased to 0.5. (D) Six months after epiretinal membrane removal, retinal folding disappeared, and macular thickness decreased to 392 μm. Her vision improved to 0.9.

Reference

References

1. Pearlstone AD. The incidence of idiopathic preretinal macular gliosis. Ann Ophthalmol. 1985; 17:378–80.

2. Wiznia RA. Natural history of idiopathic preretinal macular fibrosis. Ann Ophthalmol. 1982; 14:876–8.

3. Fraser-Bell S, Guzowski M, Rochtchina E, et al. Five-year cumulative incidence and progression of epiretinal membranes: the Blue Mountains Eye Study. Ophthalmology. 2003; 110:34–40.

4. Yang HS, Hong JW, Kim YJ, et al. Characteristics of spontaneous idiopathic epiretinal membrane separation in spectral domain optical coherence tomography. Retina. 2014; 34:2079–87.

5. Chung IY, Koh HJ, Park JM. Spontaneous separation of a secondary macular epiretinal membrane. J Korean Ophthalmol Soc. 2002; 43:1812–5.

6. Oono Y, Nakamura S, Yoshimura K, et al. Recurrence after spontaneous resolution of an idiopathic epiretinal membrane. Case Rep Ophthalmol. 2011; 2:55–8.

7. Vinores SA, Campochiaro PA, Conway BP. Ultrastructural and electron-immunocytochemical characterization of cells in epiretinal membranes. Invest Ophthalmol Vis Sci. 1990; 31:14–28.

8. Heidenkummer HP, Kampik A. Proliferative activity and immunohistochemical cell differentiation in human epiretinal membranes. Ger J Ophthalmol. 1992; 1:170–5.

9. Machemer R. Massive periretinal proliferation: a logical approach to therapy. Trans Am Ophthalmol Soc. 1977; 75:556–86.

10. Kohno RI, Hata Y, Kawahara S, et al. Possible contribution of hyalocytes to idiopathic epiretinal membrane formation and its contraction. Br J Ophthalmol. 2009; 93:1020–6.

11. Grewing R, Mester U. Results of surgery for epiretinal membranes and their recurrences. Br J Ophthalmol. 1996; 80:323–6.