Premacular membranes and glaucoma: a review of clinical and therapeutic considerations

Primary epiretinal, or more precisely termed pre macular membranes (PMM) and glaucomatous optic neuropathy are both common conditions affecting a predominantly elderly population. There are several relevant clinical and pathological considerations when they are both diagnosed in the same eye.

We systematically searched the literature to review the challenges clinicians must address when dealing with patients with co-existing PMM and glaucoma.

Although the current literature is limited there appears to be a link between the occurrence of glaucomatous optic neuropathy and idiopathic PMM. The presence of PMM can confound glaucomatous progression detection on optical coherence tomography (OCT). Vitrectomy and membrane peeling may improve vision in some patients with co-existing disease but there may be an increased risk of glaucoma progression particularly in eyes with advanced glaucoma and more extensive neuronal loss. Peeling of the retinal inner limiting membrane in addition to PMM peeling may result in an increased risk of visual loss. Inner nuclear layer hypo-reflective spaces on OCT are particularly prevalent in eyes with glaucoma and PMM and may be a negative prognostic sign for outcome.

Patients should be counseled regarding the guarded prognosis, and careful consideration given to the benefits of PMM surgery. Further research is needed to guide clinical practice.