Purpose:

Epiretinal membranes (ERM) are collections of collagenous cells that occur on the inner surface of the central retina and can lead to visual changes because of their effect on the underlying retina. This ocular pathology was first described by Iwanoff in 1865, and it has been shown to be a relatively common entity, occurring in about 7% of the population. ERM occur more frequently in the older population and both sexes appear to be affected equally. The degree of visual loss depends on the severity of the distortion of the retina, the location of the wrinkling and any other secondary effects of the membrane on the retina (e.g., edema, hemorrhage).

Methods:

The authors present a video of an ERM surgery with unusual foveolar adhesion.

Results:

A 68-year-old woman, presenting with vision loss of the right eye (OD) associated with metamorphopsias lasting more than 6 months. Ophthalmologic examination at presentation consisted of: best corrected visual acuity (BCVA) right eye (OD): 4/10, BCVA OS: 10/10; unremarkable pupillary light reflex and ocular motility; pseudophakia OD/OS; fundoscopy OD revealed ERM with irregular wrinkling of the inner retinal surface; fundoscopy OS without changes. Optical coherence tomography (OCT) confirmed the diagnosis of right ERM associated with central foveal thickening. Treatment option: Pars plana vitrectomy (PPV) 23 gauge was performed to remove cortical vitreous. A vital dye containing trypan and brilliant blue was used to stain the ERM. ERM peeling was performed in a 360 degrees rhexis. At this point, we observed an unusual foveolar adhesion that could not be relieved with internal limiting membrane (ILM) forceps. The ERM was trimmed with the vitreous cutter. Afterwards the ILM was stained with the same dye used before and ILM peeling was performed allowing the complete removal of the remnant of the ERM. The eye was tamponade with air and sclerotomies sealed by 8.0 vicryl cross-stitching. Two months after surgery the vision improved to 7/10 with resolution of the symptoms.

Conclusions:

Although performed routinely, ERM surgery can be challenging even for experienced retinal surgeons. In this case, an unusual membrane adhesion to the foveola led to a variation in the classic approach. The vitreous cutter was used to trim the membrane and the ILM peeling resulted in the complete removal of the ERM remnant.