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Review
. 2024 Jun 28;44(1):291.
doi: 10.1007/s10792-024-03199-2.

Epiretinal membranes in patients with uveitis: an update on the current state of management

Dimitrios Kalogeropoulos  1 , Andrew John Lotery  1   2 , Bhaskar Gupta  1 , Stephen Lash  1 , Serafeim Antonakis  3
Affiliations
Review

Epiretinal membranes in patients with uveitis: an update on the current state of management

Dimitrios Kalogeropoulos et al. Int Ophthalmol. .

Abstract

Purpose: This review aims to summarize the current knowledge concerning the clinical features, diagnostic work-up, and therapeutic approach of uveitic epiretinal membranes (ERM).

Methods: A thorough investigation of the literature was conducted using the PubMed database. Additionally, a complementary search was carried out on Google Scholar to ensure the inclusion of all relevant items in the collection.

Results: ERM is an abnormal layer at the vitreoretinal interface, resulting from myofibroblastic cell proliferation along the inner surface of the central retina, causing visual impairment. Known by various names, ERM has diverse causes, including idiopathic or secondary factors, with ophthalmic imaging techniques like OCT improving detection. In uveitis, ERM occurrence is common, and surgical intervention involves pars plana vitrectomy with ERM peeling, although debates persist on optimal approaches.

Conclusions: Histopathological studies and OCT advancements improved ERM understanding, revealing a diverse group of diseases without a unified model. Consensus supports surgery for uveitic ERM in progressive cases, but variability requires careful consideration and effective inflammation management. OCT biomarkers, deep learning, and surgical advances may enhance outcomes, and medical interventions and robotics show promise for early ERM intervention.

Keywords: Cytokines; Epiretinal membrane; Inflammation; Pars plana vitrectomy; Uveitis.

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Conflict of interest statement

All authors declare that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
A 42-year-old male with a history of bilateral intermediate uveitis. Optos widefield photography of the right (a) and left (b) eye illustrates bilateral vitreous debris/opacities (red asterisks) and abnormalities of the vitreoretinal interface (blue asterisks) secondary to the intraocular inflammatory activity. An epiretinal membrane (ERM) is present in both eyes, but it is more prominent in the right eye. An inferotemporal retinoschisis (green arrow) can also be observed in the left eye. No vitritis or other inflammatory features can be seen in these photos. Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany) shows the extent and anatomical features of the ERM; absence of vitreomacular traction, and no evidence of cystoid macular oedema (c: right eye, d: left eye). SD-OCT, Spectral Domain Optical Coherence Tomography
Fig. 2
Fig. 2
A uveitic epiretinal membrane (ERM) in the left eye of a 30-year-old female as depicted by different imaging modalities. Although Optos widefield photography a shows clearly the presence of the ERM, Spectralis MultiColor (Heidelberg Engineering, Heidelberg, Germany) b illustrates in detail the extent and tractional features of the ERM. Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany) c shows that there is no significant vitreomacular traction. A retinal thickening can be observed nasally (red asterisk). Moreover, a few tiny intraretinal chronic cystic spaces can be seen temporally (yellow asterisk). SD-OCT, Spectral Domain Optical Coherence Tomography
Fig. 3
Fig. 3
Suggested protocol for the management of epiretinal membranes in uveitic patients. ERM, epiretinal membrane; IRF, intraretinal fluid; OCT, Optical Coherence Tomography, VA, visual acuity
See this image and copyright information in PMC

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