Epiretinal membrane: an overview and update
1Department of Ophthalmology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho Kita-ku, Okayama City, Okayama, 700-8558, Japan. ryo-matoba@s.okayama-u.ac.jp.
Abstract:
Epiretinal membrane (ERM) is a frequently diagnosed macular disease associated with aging, characterized by a fibrous membrane forming on the internal limiting membrane (ILM) and leading to visual dysfunctions such as metamorphopsia. Various hypotheses regarding the pathology of metamorphopsia have been proposed; however, the complete pathophysiologic mechanism underlying ERM remains unclear. Optical coherence tomography (OCT) provides detailed images enabling precise diagnosis and characterization of ERM, with several recent studies using the latest OCT imaging techniques. Surgical removal of ERM is the only treatment option; however, criteria for surgical intervention are not established, complicating the decision-making processes. Furthermore, the debate on whether simultaneous peeling of the ILM during ERM surgery enhances outcomes or poses unnecessary risks is ongoing, with no definite conclusion having yet been reached. This review also focuses on epiretinal proliferation, which is different from ERM and is characteristic of lamellar macular hole (LMH). Recently, diagnostic criteria for LMH and related diseases were proposed. Reports on effective surgical procedures for LMH exist, although more research is needed to confirm the long-term outcomes. Thus, this review article aims to provide an overview and updated knowledge of ERM, LMH, and related diseases.
Insights
Epiretinal membrane (ERM) and lamellar macular hole (LMH) are common macular diseases. This review updates knowledge on their diagnosis, pathology, and surgical treatments, highlighting ongoing research needs.
Area of Science:
- Ophthalmology
- Medical Imaging
- Retinal Diseases
Background:
- Epiretinal membrane (ERM) is a common aging-related macular disease causing visual disturbances like metamorphopsia.
- The exact pathophysiologic mechanisms of ERM and metamorphopsia remain incompletely understood.
- Lamellar macular hole (LMH) involves epiretinal proliferation, distinct from ERM.
Purpose of the Study:
- To provide an updated overview of epiretinal membrane (ERM) and lamellar macular hole (LMH).
- To discuss current diagnostic techniques, particularly optical coherence tomography (OCT).
- To review treatment options and unresolved clinical questions regarding ERM and LMH.
Main Methods:
- Review of recent literature utilizing advanced optical coherence tomography (OCT) imaging.
- Analysis of diagnostic criteria for ERM, LMH, and related conditions.
- Examination of surgical outcomes and ongoing debates in ERM management.
Main Results:
- Optical coherence tomography (OCT) is crucial for diagnosing and characterizing ERM.
- Surgical removal is the only treatment for ERM, but intervention criteria are not standardized.
- The benefit and risk of simultaneous internal limiting membrane (ILM) peeling during ERM surgery are debated.
- Diagnostic criteria for LMH have been proposed, with surgical options emerging but requiring further long-term outcome validation.
Conclusions:
- Further research is needed to clarify ERM pathophysiology and establish surgical decision-making criteria.
- Long-term outcomes of surgical interventions for LMH require more investigation.
- This review consolidates current knowledge on ERM and LMH, identifying areas for future study.
