Epiretinal membrane (ERM) formation in uveitic macular oedema is a fairly common structural complication of the retina. The authors describe a retrospective case series of 104 eyes of 77 patients with uveitic macular oedema from a tertiary centre. The treatment they received varied from regional (periocular / intravitreal) cortico-steroids, oral corticosteroids, immunosuppression or a combination of regional and oral corticosteroids. The aim of the study was to characterise the effect of the ERMs on visual acuity and on improvement or resolution of the uveitic macular oedema. The ERMs were diagnosed by two investigators with the aid of spectral-domain optical coherence tomography (OCT) and they were scored for the presence or absence of surface wrinkling. This was evident on OCT as multifocal attachments between the ERM and the internal limiting membrane, creating hyporeflective spaces between them and numerous folds along the internal limiting membrane. The outcome measures included best corrected visual acuity, central subfoveal thickness, macular oedema improvement rates (>20% reduction in central subfoveal thickness) and resolution (reduction of central subfoveal thickness <315 m). The authors identified ERMs in 72 eyes of 59 patients. There was no significant difference between eyes without ERM and eyes with ERM but no surface wrinkling. However, eyes with ERMs and surface wrinkling were associated with worse vision (>2/200) at presentation and worse mean visual acuities at three and six months. Snellen acuity at three months in eyes without ERM was 20/35, in eyes with ERM but no wrinkling 20/47 and in eyes with ERM and wrinkling 20/94. Similarly at six months mean visual acuity in eyes without ERM was 20/36, in eyes with ERM but no wrinkling 20/46 and in eyes with ERM and wrinkling 20/110. In terms of structural changes, at six months the eyes without an ERM had a mean central subfoveal thickness of 338 +/-23m, eyes with an ERM but no surface wrinkling had a mean central subfoveal thickness of 332+/-20m, whereas eyes with an ERM and surface wrinkling had mean values of 405+/-22m. The authors concluded that eyes with uveitic macular oedema aggravated by the formation of ERM with wrinkling had a poorer visual acuity outcome, worse response to treatment and thicker maculae at six months. The authors were aware of the limitation of their study because of small sample size, its retrospective nature and possible referral bias and recommended caution in interpreting their results.
Epiretinal membranes in uveitic macular oedema
Reviewed by Efrosini Papagiannuli
Epiretinal membranes in uveitic macular oedema: effect on vision and response to therapy.
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Efrosini Papagiannuli
Birmingham and Midland Eye Centre, Birmingham, UK
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