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Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and
Ahmad M Mansour1, Hana A Mansour2, J Fernando Arevalo3
1Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon ; Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.
Abstract:
This patient presented for surgery at the age of 32 years, 14 months after his initial complaint of metamorphopsia and visual loss in the right eye. Past tests demonstrated a whitish epiretinal membrane (ERM) with translucent stress lines over a thickened macula. Visual acuity was found on last presentation to be normal with minimal alteration on Amsler grid testing. A torn ERM was found in the center with left-over ERM temporally and rolled-over ERM nasally at the site of the epicenter with no posterior vitreous detachment. Visual recovery occurred gradually over several days 2 months prior to presentation apparently following heavy weight-lifting with a sensation of severe eye pressure. Sequential funduscopy and optical coherence tomography scans demonstrated the peeling of an ERM accompanied by normalization of foveal thickness. Valsalva maneuver had put excessive tension on ERM which tore in its center at the weakest line with gradual contraction of the ERM away from the fovea towards the peripapillary area. This is a new mechanism of self-separation of ERM induced by Valsalva. ERM in young subjects is subject to rupture and subsequent separation by tangential traction. There are three mechanisms for spontaneous separation of ERM: 1) posterior vitreous detachment with pulling of ERM by detaching vitreous (most common in adults); 2) the contracting forces of the immature ERM become stronger than its adhesions to the retina resulting in slow tangential traction on the edges of the ERM and gradual separation from the edges towards the center (remodeling common in youngsters); and 3) acute tearing of ERM at its weakest central point and retraction of part of the membrane towards the epicenter (current case report).
Insights
A novel mechanism for epiretinal membrane (ERM) separation was observed in a young patient following a Valsalva maneuver. This event, induced by excessive eye pressure, led to the ERM tearing and spontaneous separation, improving vision.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Surgical Case Reports
Background:
- Epiretinal membranes (ERMs) can cause visual disturbances like metamorphopsia and vision loss.
- ERM separation typically occurs through posterior vitreous detachment or inherent contractile forces, especially in younger individuals.
- Spontaneous ERM separation mechanisms are crucial for understanding visual recovery and treatment strategies.
Observation:
- A 32-year-old patient experienced visual loss due to an ERM.
- The ERM spontaneously tore centrally after a Valsalva maneuver (heavy weight-lifting).
- Optical coherence tomography confirmed ERM peeling and foveal normalization.
Findings:
- A new mechanism of ERM self-separation induced by excessive tangential traction from the Valsalva maneuver is described.
- This acute tearing mechanism differs from spontaneous separation via vitreous detachment or slow remodeling.
- Younger patients' ERMs may be more susceptible to rupture due to tangential traction.
Implications:
- This case highlights a previously unrecognized cause of ERM separation.
- Understanding this mechanism may inform management strategies for ERM in young individuals.
- Further research into ERM biomechanics and tractional forces is warranted.
