Epimacular Membrane Clinical Presentation

  • Author: Kean Theng Oh, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 16, 2012
 

History

The type and degree of symptoms experienced by the patient depends largely on the thickness of the membrane, the degree of retinal distortion it causes, the location of the wrinkling, and the presence or the absence of retinal detachment or edema.[3]

  • The usual symptoms caused by EMMs run the spectrum from no symptoms at all to severe visual dysfunction.
    • Early on, EMMs cause little or no visual disturbance.
    • As the membrane progresses, the visual disturbance is often vague and difficult for the patient to describe.
    • Mild distortion or blurring is the most common symptom.
    • Vision better than 20/50 is present in 78-85% of cases, while 56-67% have vision better than 20/30. Only 2-5% have vision poorer than 20/200.
    • In more advanced cases, metamorphopsia, micropsia, or Amsler Grid abnormalities may be present.
    • In contrast, vision is markedly reduced in patients with EMMs associated with retinal detachment. Vision is 20/60 or better in only 7% of cases and 56% have vision poorer than 20/200 after successful retinal reattachment surgery.
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Physical

The clinical findings in EMMs vary according to the degree of severity of the membrane. Gass formulated a classification system based on the appearance of the membrane and the underlying retinal tissue and vessels.

  • Grade 0 membranes
    • Grade 0 EMMs are translucent membranes not associated with any retinal distortion.
    • These EMMs also are known as cellophane maculopathy owing to the cellophanelike sheen coming from the inner retinal surface as it is seen ophthalmoscopically.
  • Grade 1 membranes
    • Membranes causing an irregular wrinkling of the inner retinal surface are classified as grade 1 EMMs.
    • The crinkled cellophane appearance is caused by the gathering of the inner retinal layers into folds following the contraction of the overlying membrane.
    • Fine, superficial, radiating folds extend outward from the margins of the contracted membrane.
    • Wrinkling may be sufficient to produce tortuosity of the paramacular vessels pulling them toward the fovea.
    • Cystoid macular edema, retinal hemorrhage, exudates, and RPE disturbances are typically absent.
  • Grade 2 membranes
    • Membranes, especially those that develop after retinal detachment surgery, have an opaque, thick appearance.
    • Gross, full-thickness puckering of the macula may be present along with retinal edema, small hemorrhages, cotton-wool spots, and, infrequently, a localized detachment of the retina.
    • These membranes are labeled macular puckers or grade 2 membranes.
  • Pseudoholes (See the image below.)Grade 2 epimacular membrane causing striations in Grade 2 epimacular membrane causing striations in the retinal surface. Note the presence of a pseudohole.
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Causes

See Pathophysiology.

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Contributor Information and Disclosures
Author

Kean Theng Oh, MD  Consulting Staff, Associated Retinal Consultants, PC

Kean Theng Oh, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Coauthor(s)

Bradley M Hughes, MD  Assistant Professor, Department of Ophthalmology, Retina and Vitreous Service, University of Arkansas for Medical Sciences

Bradley M Hughes, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Ophthalmology

Disclosure: Nothing to disclose.

John H Drouilhet, MD, FACS  Clinical Professor, Department of Surgery, Section of Ophthalmology, University of Hawaii, John A Burns School of Medicine

John H Drouilhet, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

V Al Pakalnis, MD, PhD  Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians and Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society

Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Other; Topcon Medical Lasers Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Sherman O Valero, MD, to the development and writing of this article.

References

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Very dense epimacular membrane with associated macular distortion.
Grade 2 epimacular membrane causing striations in the retinal surface. Note the presence of a pseudohole.
Fluorescein angiogram demonstrating retinal vascular distortion. Note the leakage of the dye in the macular area, which represents secondary macular edema.
 
 
 
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