Idiopathic epiretinal membrane: progression and timing of surgery

Abstract

Primary idiopathic epiretinal membrane (iERM) is a common finding, particularly so in the era of high street spectral-domain optical coherence tomography. Clinicians often face the dilemma of early versus delayed surgical intervention in the management of iERM with macular pucker, especially in those patients with good vision. The aim of this review is to assist clinicians in their understanding of the natural history of iERM to enable decision-making and optimally advising patients. We systematically searched the Medline and EMBASE databases for relevant publications from 2001 onwards using defined search terms with pre-planned inclusion and exclusion criteria. In this article, we review the epidemiology of iERM, classifications, their effect on visual function, the natural history and factors predicting progression and finally, factors which might predict the visual outcome with surgery.

Fig. 1. Retinal effects of idiopathic epiretinal membrane.

Pictures a–d show classification system as proposed by Govetto et al.; a Stage 1- presence of foveal pit and well-defined retinal layer; b Stage 2- absence of foveal pit with well-defined retinal layers; c Stage 3- presence of EIFL, absence of foveal pit with well-defined retinal layer; d Stage 4 presence of EIFL with no foveal pit and disrupted retinal layer; e ERM schisis; f Pseudohole with ERM. Pictures g–i show tractional abnormalities of the central foveal bouquet in ERM; g ‘Cotton ball sign’ with small, fuzzy hyper-reflective area observed between the ellipsoid zone; h Foveolar detachment with a central hyporeflective pocket of subretinal fluid under the inter-digitation zone; i Acquired vitelliform lesion with a thick dome-shaped hyper-reflective acquired vitelliform lesion between the retinal pigment epithelium and the outer retina; j VMT and ERM; k lamellar macular hole with epiretinal proliferation. EIFL ectopic inner fovea layer, VMT vitreomacular traction.