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Central Microscotoma: A Rare Presentation of Epiretinal Membranes
Background And Objective:
Patients with a symptomatic epiretinal membrane (ERM) typically complain of metamorphopsia and decreased visual acuity. We describe three patients who presented with the single complaint of a central microscotoma due to ERM, an infrequent initial symptom of this entity.
Patients And Methods:
This is a retrospective, interventional, non-comparative case series. Three patients with the chief complaint of a central microscotoma related to ERMs who underwent pars plana vitrectomy by a single surgeon experienced full resolution of the preoperative microscotoma. Best-corrected visual acuity, fundus photography, and optical coherence tomography were obtained at each examination. A comprehensive neuro-ophthalmologic evaluation was performed in all cases, including magnetic resonance imaging of the orbits and brain, automated visual fields, multifocal electroretinography, multifocal visually evoked potentials, and blood tests.
Results:
Three eyes of three patients who presented with the initial sole complaint of a central microscotoma due to ERM are included in this series. A comprehensive neuro-ophthalmologic evaluation ruled out non-retinal etiologies. After months of observation, a pars plana vitrectomy with ERM and internal limiting membrane peeling was performed in all patients. Postoperatively, the patients experienced a complete resolution of their initial, isolated complaint of a central microscotoma.
Conclusion:
Central microscotoma, as a rare stand-alone presentation of ERM, is described. This symptom resolved after a successful removal of the ERM. A greater awareness among clinicians that ERMs may present in this manner may help avoid excessive and costly medical evaluations.
Insights
Epiretinal membranes (ERMs) can rarely cause a central blind spot (microscotoma) as the only symptom. Surgical removal of the ERM effectively resolved this isolated visual disturbance in three patients.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Surgical Case Series
Background:
- Epiretinal membranes (ERMs) typically cause metamorphopsia and reduced visual acuity.
- Central microscotoma is an uncommon initial presentation of ERM.
Observation:
- Three patients presented with a sole complaint of central microscotoma.
- Comprehensive neuro-ophthalmologic evaluations ruled out other causes.
- Pars plana vitrectomy with ERM peeling was performed.
Findings:
- All three patients experienced complete resolution of their central microscotoma post-surgery.
- Pars plana vitrectomy effectively treated the isolated symptom.
Implications:
- Clinicians should consider ERM in cases of isolated central microscotoma.
- Early diagnosis and surgical intervention can resolve this rare ERM presentation.
- Increased awareness may prevent unnecessary diagnostic workups.
