Epiretinal Membrane with Macular Pseudohole
Visual Outcome of Surgery for Epiretinal Membranes with Macular Pseudoholes
Patient Data
Impression and Plan
Objective: Evaluate effect of macular pseudohole on vision after ERM surgery
- 437 patients w/ ERM had surgery
- 68 patients had a pseudohole in one eye
- Results compared to 50 patients w/ no pseudohole that had ERM surgery
- Pseudohole: 80% had VA of 20/50 or better w/ avg improvement of 2.72 lines
- No pseudohole: 72% reached VA of 20/50 or better w/ avg improvement of 2.62 lines
- VA (sc)
- 20/30 OD, 20/30-2 OS, 20/25-2 OU
- Manifest
- OD: +1.00-0.50x82 DVA 20/20
- OS: +1.50-0.50x105 DVA 20/20
- NCT 16 OD/OS
- SLE
- PVD OS
- C/D ratio: 0.1 OD/OS
- ERM, OS
Conclusion
Patient Data
1. Epiretinal Membrane with traction causing macular pseudohole, OS
2. Hyperopia
3. Astigmatism
4. Presbyopia
OCT OD
Risk Factors
- Diabetes
- Hypercholesterolemia
- Narrower arteriolar caliber
- 60 yo WF
- CC: Decreased vision, distance and near x 1 year, OU
- LEE: 2012
- Wears +1.75 OTC readers
- Ocular Hx:
- Trichiasis, OS
- Episode of "millions of floaters" 10 years ago, OS
- Flashes of light occasionally, OS
- Medical Hx:
- Hyperlipidemia
- Hypothyroid
- Unsure on exact prevalence of ERM but fairly common in elderly population
- ERMs are frequently asymptomatic and do not require surgery
- Prognosis is dependent on type of ERM
- Pseudoholes can disappear after surgery
- Presence of a pseudohole does not indicate a poor prognosis and VA after surgery is generally good
Epiretinal Membranes
Categories
- Proliferation of retinal glial cells that have accessed the retinal surface through breaks in ILM
- Causes:
- Idiopathic
- Secondary- following a retinal procedure, vascular disease, intraocular inflammation, or ocular trama
1. Cellophane maculopathy
- common, secondary to PVD
- frequently asymptomatic
- irregular light reflex or sheen at macula
- not usually treated
2. Macular pucker
- thickening & contraction of ERM
- less common
- metamorphopsia, decreased VA
- distortion of BVs, white striae
- macular pseudoholes and/or CME
- surgical removal
- Prevalence increased with age but had no difference between men and women
* Other studies have reported overall lower
percentages- attributable to different study
designs, photos, samples, and grading
OCT OS
3 months after surgery
- Pseudohole disappeared from 28 eyes and persisted in 22
6 months after surgery
- Pseudohole persisted in 15 eyes
* No difference in VA whether
pseudohole persisted or not
Prevalence
1. Ng CH, Cheung N, Wang JJ, et al. Prevalence and Risk Factors for Epiretinal Membranes in a Multi-Ethnic United States Population. Ophthalmology. 2011;118(4):694-699.
2. Massin P, Paques M, Masri H, et al. Visual Outcome of Surgery for Epiretinal Membranes with Macular Pseudoholes. Ophthalmology. 1999; 106(3):580-585.
3. Kanski J. Clinical Ophthalmology A Clinical Approach. 6th ed. Philadelphia: Elsevier, 2007.
Multi-ethnic study
- 6176 participants from 6 U.S. communities
- Fundus photos taken and assessed for ERM- classified into 2 categories
- ERM present in 28.9% of participants; 35% had bilateral ERMs
- Chinese: 39%
- Hispanics: 29.3%
- Whites: 27.5%
- Blacks: 26.2%