Epimacular Membrane Workup

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

Imaging Studies

  • Fluorescein angiography
    • Performing an angiogram in cases of EMMs does not contribute anything significant in its diagnosis since the clinical picture is often specific enough. In less advanced cases, the angiographic picture is basically unremarkable. More significant findings, such as vessel tortuosity and macular edema, may be seen in more advanced cases.
    • Perform fluorescein angiography to rule out other lesions that may mimic EMMs.
    • Macular holes typically show early background fluorescence through the hole that disappears in the later phases.
    • EMMs with pseudoholes typically do not exhibit this fluorescence since normal retinal tissue exists in the area.
    • An exudative macular degeneration also may mimic the appearance of an EMM, but its angiographic picture of early fluorescence and leakage is easily distinguishable from EMMs.
    • Fluorescein angiograms of EMMs can reveal subtle leakage of the perifoveal capillaries or evidence of ischemia due to capillary dropout, which can assist with counseling for postoperative expectations. See the image below. Fluorescein angiogram demonstrating retinal vasculFluorescein angiogram demonstrating retinal vascular distortion. Note the leakage of the dye in the macular area, which represents secondary macular edema.
  • Ocular coherence tomography
    • Ocular coherence tomography (OCT) can elucidate the presence or absence of an EMM.
    • OCT can objectively measure other effects of the EMM on the retina, such as macular thickening, presence or absence of macular edema (eg, cystoid macular edema), and any associated vitreous traction on the retina.
    • OCT allows the monitoring of the postoperative return of the normal retinal architecture as well as the presence of persistent traction or folds of the retina.
    • Gupta et al used combined OCT/scanning laser ophthalmoscopy (SLO) to evaluate 44 consecutive eyes with EMM.[4]
      • Of the patients evaluated, 20 out of 44 demonstrated multiple foci of contracture within the EMM. They subdivided EMM into “simple puckers" and “complex puckers.”
      • Complex puckers had a higher rate of intraretinal cysts and macular thickening than simple puckers.
      • However, no difference in visual dysfunction existed between the two groups; the authors hypothesize that architectural differences in the retina may precede visual acuity loss.
Proceed to Treatment & Management
 
 
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

  1. Chang LK, Fine HF, Spaide RF, et al. Ultrastructural correlation of spectral-domain optical coherence tomographic findings in vitreomacular traction syndrome. Am J Ophthalmol. Jul 2008;146(1):121-7. [Medline].

  2. Bovey EH, Uffer S. Tearing and folding of the retinal internal limiting membrane associated with macular epiretinal membrane. Retina. Mar 2008;28(3):433-40. [Medline].

  3. Karacorlu M, Ozdemir H, Senturk F, Karacorlu SA, Uysal O. Correlation of retinal sensitivity with visual acuity and macular thickness in eyes with idiopathic epimacular membrane. Int Ophthalmol. Jun 2010;30(3):285-90. [Medline].

  4. Gupta P, Sadun AA, Sebag J. Multifocal retinal contraction in macular pucker analyzed by combined optical coherence tomography/scanning laser ophthalmoscopy. Retina. Mar 2008;28(3):447-52. [Medline].

  5. Gupta OP, Ho AC, Kaiser PK, et al. Short-term outcomes of 23-gauge pars plana vitrectomy. Am J Ophthalmol. Aug 2008;146(2):193-197. [Medline].

  6. Gupta OP, Weichel ED, Regillo CD, et al. Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging. Jul-Aug 2007;38(4):270-5. [Medline].

  7. Charles S. Epimacular Membranes. In: Guyer DR, Yannuzzi LA, Chang S, et al. Retina-Vitreous-Macula. Vol 2. Philadelphia, Pa: WB Saunders Co; 1999:230-7.

  8. Haritoglou C, Gandorfer A, Gass CA, et al. The effect of indocyanine-green on functional outcome of macular pucker surgery. Am J Ophthalmol. Mar 2003;135(3):328-37. [Medline].

  9. Casparis H, Bovey EH. Surgical treatment of lamellar macular hole associated with epimacular membrane. Retina. Oct 2011;31(9):1783-90. [Medline].

  10. Hillenkamp J, Saikia P, Herrmann WA, et al. Surgical removal of idiopathic epiretinal membrane with or without the assistance of indocyanine green: a randomised controlled clinical trial. Graefes Arch Clin Exp Ophthalmol. Jul 2007;245(7):973-9. [Medline].

  11. Garweg JG, Bergstein D, Windisch B, et al. Recovery of visual field and acuity after removal of epiretinal and inner limiting membranes. Br J Ophthalmol. Feb 2008;92(2):220-4. [Medline].

  12. Gass JDM. Macular dysfunction caused by epiretinal membrane contraction. In: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment. Vol 2. 4th ed. St. Louis, Mo: Mosby; 1997:938-950.

  13. Haritoglou C, Gandorfer A, Schaumberger M, et al. Trypan blue in macular pucker surgery: an evaluation of histology and functional outcome. Retina. Aug 2004;24(4):582-90. [Medline].

  14. Marghero RR. Epiretinal macular membranes. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Vol 2. Philadelphia, Pa: WB Saunders Co; 1994:919-925.

  15. McDonald HR, Schatz H, Johnson RN. Introduction to epiretinal membranes. In: Ryan SJ, ed. Retina. Vol 2. 2nd ed. St. Louis, Mo: Mosby; 1994:1819-1825.

  16. Russell SR, Crapotta JA. Macular epiretinal membranes. Ophthalmol Clin North Am. June 1993;6(2):239-45.

  17. Sjaarda RN, Michels RG. Macular pucker. In: Ryan SJ, ed. Retina. Vol 3. 2nd ed. St. Louis, Mo: Mosby; 1994:2301-2312.

  18. Ting FS, Kwok AK. Treatment of epiretinal membrane: an update. Hong Kong Med J. Dec 2005;11(6):496-502. [Medline].

  19. Wong JG, Sachdev N, Beaumont PE, et al. Visual outcomes following vitrectomy and peeling of epiretinal membrane. Clin Experiment Ophthalmol. Aug 2005;33(4):373-8. [Medline].

 
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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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