Epiretinal membrane: optical coherence tomography-based diagnosis and classification

Abstract

Epiretinal membrane (ERM) is a disorder of the vitreomacular interface characterized by symptoms of decreased visual acuity and metamorphopsia. The diagnosis and classification of ERM has traditionally been based on clinical examination findings. However, modern optical coherence tomography (OCT) has proven to be more sensitive than clinical examination for the diagnosis of ERM. Furthermore, OCT-derived findings, such as central foveal thickness and inner segment ellipsoid band integrity, have shown clinical relevance in the setting of ERM. To date, no OCT-based ERM classification scheme has been widely accepted for use in clinical practice and investigation. Herein, we review the pathogenesis, diagnosis, and classification of ERMs and propose an OCT-based ERM classification system.

Keywords: cellophane macular reflex; central foveal thickness; inner segment ellipsoid band; macular pucker; optical coherence tomography; preretinal macular fibrosis.

Figure 1

Epiretinal membrane examples. Notes: (A) Color fundus photograph demonstrating subtle cellophane macular reflex. (B) Spectralis OCT scan through the central fovea of (A) demonstrating a primary epiretinal membrane without significant retinal thickening (central foveal thickness of 274 μm) with an intact inner segment ellipsoid band. (C) Color fundus photograph demonstrating preretinal macular fibrosis. (D) Spectralis OCT scan through the central fovea of (C) demonstrating a primary epiretinal membrane with significant retinal thickening (central foveal thickness of 364 μm) with an intact inner segment ellipsoid band. Abbreviation: OCT, optical coherence tomography.