FOCAL DETACHMENT OF FOVEA IN PATIENTS WITH IDIOPATHIC EPIRETINAL MEMBRANE Murat Karacorlu, MD, MSC, Hakan Ozdemir, MD, Serra Arf Karacorlu, MD
Purpose: To report three cases of focal foveal detachment evident by optical coherence tomography (OCT) in idiopathic epiretinal membrane (ERM). Methods: A retrospective case series of three patients who had focal foveal detachment shown by OCT and recent visual deterioration and metamorphopsia due to idiopathic ERM. Results: Three patients with idiopathic ERM had recent visual deterioration and metamorphopsia. Although fundus examination, fluorescein angiography, and central macular thickness findings were stable, focal foveal detachment was identified by OCT in all patients. Conclusion: Our findings suggest a sequence of events to explain the OCT findings for and visual changes in these three patients. It is probable that contraction of the ERM on the surface of the retina may have led to dragging of the outer structure in the retina, resulting in focal detachment of the fovea. RETINAL CASES & BRIEF REPORTS 1:215–216, 2007
From The Istanbul Retina Institute Inc., Istanbul, Turkey.
1A). Visual acuity is now 20/50 and central macular thickness has increased to 469 m. In addition to the ERM, the OCT reveals a focal neurosensory detachment of the fovea (Figure 1B). Angiography was also performed and did not demonstrate any change over the same time period to account for the decrease in vision.
E
piretinal membranes (ERMs) are common, typically affecting patients older than 50 years. They may be idiopathic or secondary to a variety of ocular conditions such as trauma, retinal vascular diseases, and vitreous hemorrhage. The patient may experience reduced visual acuity and/or metamorphopsia as a result of the ERM.1 In most patients, visual acuity remains stable, and those who do experience visual loss have a slowly progressive course.2 In this article we report three patients with idiopathic ERM in whom the visual loss and metamorphopsia progressed quickly and in whom optical coherence tomography (OCT) showed a focal detachment of fovea.
Case 2 A 61-year-old woman diagnosed with idiopathic ERM 1 year ago presented with 2 weeks of blurred vision and metamorphopsia in the left eye. Examination 1 month ago revealed a visual acuity of 20/20. OCT demonstrated a reflective band on the surface of the retina consistent with ERM and a central macular thickness of 365 m (Figure 2A). Visual acuity is now 20/32 and OCT shows a central thickness of 373 m with a focal detachment of the neurosensory retina at the fovea (Figure 2B). Angiography was performed and did not demonstrate any change over the same time period to account for the decrease in vision.
Case Reports
Case 3 A 71-year-old man diagnosed with idiopathic ERM 16 months ago presented with 2 days of blurred vision and metamorphopsia in the right eye. Examination 1 month ago revealed a visual acuity of 20/32. OCT demonstrated a reflective band on the surface of the retina consistent with ERM and a central macular thickness of 414 m (Figure 3A). Vision is now 20/63 and OCT shows a central thickness of 428 m with a focal detachment of the neurosensory retina at the fovea (Figure 3B). Angiography was performed and did not demonstrate choroidal neovascularization or other abnormality to explain the change in vision.
Case 1 A 68-year-old man diagnosed with ERM 2 years previously presented with 1 week of blurred vision and metamorphopsia in the right eye. Examination 4 months ago revealed a visual acuity of 20/32 and a central macular thickness of 465 m by OCT (Figure Reprint requests: Murat Karacorlu, MD, MSc, Istanbul Retina Institute, Inc., Unimed Center, Hakki Yeten Cad. No:8/7, 34349 Sisli, Istanbul, Turkey; e-mail: [email protected]
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Fig. 1. Case 1. A 68-year-old man with a 1-week history of blurred vision and metamorphopsia in his right eye. He had a diagnosis of idiopathic epiretinal membranes (ERMs) in his right eye for 2 years. At the previous examination optical coherence tomography (OCT) showed a reflective band on the surface of the retina corresponding to the ERM. Central macular thickness was 465 m (A). At the last examination his visual acuity was decreased from 20/32 to 20/50. OCT showed an outer retinal defect in the fovea. The central macular thickness was 469 m (B).
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Fig. 3. Case 3. A 71-year-old man with 2 days history of blurred vision and metamorphopsia in his right eye. He had a diagnosis of idiopathic epiretinal membranes (ERMs) in his right eye for 16 months. At the previous examination optical coherence tomography (OCT) showed a reflective band on the surface of the retina corresponding to the ERM. Central macular thickness was 414 m (A). At the last examination his visual acuity was decreased from 20/32 to 20/63. OCT showed an outer retinal defect in the fovea. The central macular thickness was 428 m (B).
Discussion The so-called idiopathic type of ERM has been shown to be caused by glial proliferation through a defect in the internal limiting lamina, usually created by a posterior vitreous separation.3,4 The typical ERM patient experi-
ences a relatively slow loss of vision accompanied by metamorphopsia over a period of several months.2 In this case series we have reported three patients who were seen with rapidly progressive visual loss and metamorphopsia caused by idiopathic ERM. Although the fundus examination, angiographic findings, and central macular thickness remained stable, OCT examinations showed a focal detachment of fovea in all patients that previously did not exist. These findings suggest a sequence of events to explain the OCT findings and visual changes in these three patients. It is probable that the contraction of the ERM on the surface of the retina may lead to dragging of the outer structure in the retina leading to the focal detachment of fovea. This case series demonstrates one possible way that ERM may decrease vision and how OCT can further improve our understanding of such conditions. References 1.
Fig. 2. Case 2. A 61-year-old woman diagnosed with epiretinal membranes (ERMs) 1 year previously presented with 2 weeks of blurred vision and metamorphopsia in her left eye. Examination 1 month ago revealed a visual acuity of 20/20 and a central macular thickness of 365 m by optical coherence tomography (OCT) (A). Visual acuity is now 20/32 and central macular thickness has increased to 373 m. In addition to the ERM, the OCT reveals a focal neurosensory detachment of the fovea (B).
2. 3.
4.
McDonald HR, Johnson RN, Ai E, Schatz H. Macular epiretinal membranes. In: Ryan SJ, ed. Retina, 3rd ed. St Louis: Mosby, 2001;3:2531–2546. Appiah AP, Hirose T, Kado M. A review of 324 cases of idiopathic premacular gliosis. Am J Ophthalmol 1988;106:533–535. Hirokawa H, Jalkh AE, Takahashi M, et al. Role of the vitreous in idiopathic macular fibrosis. Am J Ophthalmol 1988;106:536–545. Kishi S, Shimizu K. Oval defect in detached posterior hyaloid membrane in idiopathic preretinal fibrosis. Am J Ophthalmol 1994;118:451–456.
Purpose: To report three cases of focal foveal detachment evident by optical coherence tomography (OCT) in idiopathic epiretinal membrane (ERM). Methods: A retrospective case series of three patients who had focal foveal detachment shown by OCT and recent visual deterioration and metamorphopsia due to idiopathic ERM. Results: Three patients with idiopathic ERM had recent visual deterioration and metamorphopsia. Although fundus examination, fluorescein angiography, and central macular thickness findings were stable, focal foveal detachment was identified by OCT in all patients. Conclusion: Our findings suggest a sequence of events to explain the OCT findings for and visual changes in these three patients. It is probable that contraction of the ERM on the surface of the retina may have led to dragging of the outer structure in the retina, resulting in focal detachment of the fovea. RETINAL CASES & BRIEF REPORTS 1:215–216, 2007
From The Istanbul Retina Institute Inc., Istanbul, Turkey.
1A). Visual acuity is now 20/50 and central macular thickness has increased to 469 m. In addition to the ERM, the OCT reveals a focal neurosensory detachment of the fovea (Figure 1B). Angiography was also performed and did not demonstrate any change over the same time period to account for the decrease in vision.
E
piretinal membranes (ERMs) are common, typically affecting patients older than 50 years. They may be idiopathic or secondary to a variety of ocular conditions such as trauma, retinal vascular diseases, and vitreous hemorrhage. The patient may experience reduced visual acuity and/or metamorphopsia as a result of the ERM.1 In most patients, visual acuity remains stable, and those who do experience visual loss have a slowly progressive course.2 In this article we report three patients with idiopathic ERM in whom the visual loss and metamorphopsia progressed quickly and in whom optical coherence tomography (OCT) showed a focal detachment of fovea.
Case 2 A 61-year-old woman diagnosed with idiopathic ERM 1 year ago presented with 2 weeks of blurred vision and metamorphopsia in the left eye. Examination 1 month ago revealed a visual acuity of 20/20. OCT demonstrated a reflective band on the surface of the retina consistent with ERM and a central macular thickness of 365 m (Figure 2A). Visual acuity is now 20/32 and OCT shows a central thickness of 373 m with a focal detachment of the neurosensory retina at the fovea (Figure 2B). Angiography was performed and did not demonstrate any change over the same time period to account for the decrease in vision.
Case Reports
Case 3 A 71-year-old man diagnosed with idiopathic ERM 16 months ago presented with 2 days of blurred vision and metamorphopsia in the right eye. Examination 1 month ago revealed a visual acuity of 20/32. OCT demonstrated a reflective band on the surface of the retina consistent with ERM and a central macular thickness of 414 m (Figure 3A). Vision is now 20/63 and OCT shows a central thickness of 428 m with a focal detachment of the neurosensory retina at the fovea (Figure 3B). Angiography was performed and did not demonstrate choroidal neovascularization or other abnormality to explain the change in vision.
Case 1 A 68-year-old man diagnosed with ERM 2 years previously presented with 1 week of blurred vision and metamorphopsia in the right eye. Examination 4 months ago revealed a visual acuity of 20/32 and a central macular thickness of 465 m by OCT (Figure Reprint requests: Murat Karacorlu, MD, MSc, Istanbul Retina Institute, Inc., Unimed Center, Hakki Yeten Cad. No:8/7, 34349 Sisli, Istanbul, Turkey; e-mail: [email protected]
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Fig. 1. Case 1. A 68-year-old man with a 1-week history of blurred vision and metamorphopsia in his right eye. He had a diagnosis of idiopathic epiretinal membranes (ERMs) in his right eye for 2 years. At the previous examination optical coherence tomography (OCT) showed a reflective band on the surface of the retina corresponding to the ERM. Central macular thickness was 465 m (A). At the last examination his visual acuity was decreased from 20/32 to 20/50. OCT showed an outer retinal defect in the fovea. The central macular thickness was 469 m (B).
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Fig. 3. Case 3. A 71-year-old man with 2 days history of blurred vision and metamorphopsia in his right eye. He had a diagnosis of idiopathic epiretinal membranes (ERMs) in his right eye for 16 months. At the previous examination optical coherence tomography (OCT) showed a reflective band on the surface of the retina corresponding to the ERM. Central macular thickness was 414 m (A). At the last examination his visual acuity was decreased from 20/32 to 20/63. OCT showed an outer retinal defect in the fovea. The central macular thickness was 428 m (B).
Discussion The so-called idiopathic type of ERM has been shown to be caused by glial proliferation through a defect in the internal limiting lamina, usually created by a posterior vitreous separation.3,4 The typical ERM patient experi-
ences a relatively slow loss of vision accompanied by metamorphopsia over a period of several months.2 In this case series we have reported three patients who were seen with rapidly progressive visual loss and metamorphopsia caused by idiopathic ERM. Although the fundus examination, angiographic findings, and central macular thickness remained stable, OCT examinations showed a focal detachment of fovea in all patients that previously did not exist. These findings suggest a sequence of events to explain the OCT findings and visual changes in these three patients. It is probable that the contraction of the ERM on the surface of the retina may lead to dragging of the outer structure in the retina leading to the focal detachment of fovea. This case series demonstrates one possible way that ERM may decrease vision and how OCT can further improve our understanding of such conditions. References 1.
Fig. 2. Case 2. A 61-year-old woman diagnosed with epiretinal membranes (ERMs) 1 year previously presented with 2 weeks of blurred vision and metamorphopsia in her left eye. Examination 1 month ago revealed a visual acuity of 20/20 and a central macular thickness of 365 m by optical coherence tomography (OCT) (A). Visual acuity is now 20/32 and central macular thickness has increased to 373 m. In addition to the ERM, the OCT reveals a focal neurosensory detachment of the fovea (B).
2. 3.
4.
McDonald HR, Johnson RN, Ai E, Schatz H. Macular epiretinal membranes. In: Ryan SJ, ed. Retina, 3rd ed. St Louis: Mosby, 2001;3:2531–2546. Appiah AP, Hirose T, Kado M. A review of 324 cases of idiopathic premacular gliosis. Am J Ophthalmol 1988;106:533–535. Hirokawa H, Jalkh AE, Takahashi M, et al. Role of the vitreous in idiopathic macular fibrosis. Am J Ophthalmol 1988;106:536–545. Kishi S, Shimizu K. Oval defect in detached posterior hyaloid membrane in idiopathic preretinal fibrosis. Am J Ophthalmol 1994;118:451–456.
