epiretinale

Epiretinale, or epiretinal membrane (ERM), is a semi-transparent fibrocellular layer that forms on the inner surface of the retina, most often over the macula. The membrane can contract over time, exerting traction on the underlying retinal tissue and distorting the foveal contour, which may affect visual acuity and cause metamorphopsia.

Etiology and classification include idiopathic ERMs, commonly related to aging, and secondary ERMs that develop after retinal breaks or surgery, diabetic retinopathy, retinal vein occlusions, inflammatory diseases, or trauma. The pathophysiology involves cellular proliferation on the inner limiting membrane and subsequent membrane contraction, leading to wrinkling of the retinal surface.

Symptoms typically include gradual decrease in central vision, distortion of straight lines (metamorphopsia), and sometimes micropsia. Some ERMs are asymptomatic and found incidentally during examination.

Diagnosis is based on clinical examination and imaging. Fundoscopy may reveal a wrinkled, puckered macula. Optical coherence tomography (OCT) is the primary diagnostic tool, showing a cellophane-like layer adherent to the inner retina with distortion of the foveal architecture and possible cystic changes. Fluorescein angiography is less commonly required.

Management ranges from observation for mild or asymptomatic cases to surgical intervention for vision impairment. Pars plana vitrectomy with peeling of the ERM is the standard surgical approach; peeling the internal limiting membrane (ILM) is sometimes performed to reduce recurrence. Cataract extraction may be combined in phakic patients. Outcomes are generally favorable, with improvement in visual acuity and metamorphopsia in many patients, though duration of symptoms and macular damage influence results. Potential complications include cataract progression after vitrectomy, retinal tears or detachment, infection, and ERM recurrence.