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Br J Ophthalmol. 2007 September; 91(9): 1252–1253.
PMCID: PMC1954932

Spontaneous resolution of an inflammation‐associated epiretinal membrane with previously documented posterior vitreous detachment

Although resolution of idiopathic epiretinal membranes (ERM) with a subsequent posterior vitreous detachment (PVD) has been reported, we report a rare case of resolution of an inflammation‐associated ERM in a young patient that was associated with a pre‐existing PVD.1,2,3

Case report

A 16‐year‐old white man with a history of intermediate uveitis and negative systemic work‐up was seen at the Barnes Retina Institute for marked distortion and decreased visual acuity. Visual acuity was 20/20 in the unaffected right eye, 20/70 with marked distortion in the left eye. Fundus examination of the left eye revealed a previously noted Weiss ring, and a distinct cellular epiretinal membrane (ERM) with associated retinal thickening and distortion (fig 1A–E). Fluorescein angiography showed intraretinal leakage associated with the ERM (fig 1C1C).). Treatment options including surgery were discussed but the patient elected to observe. Five months later, visual acuity was 20/25 in the left eye and Amsler grid testing showed no distortion. The ERM had spontaneously resolved with minimal retinal folds remaining (fig 2B2B);); there was no leakage on fluorescein angiographhy (fig 2C2C);); optical coherence tomography (OCT) showed significant resolution of neurosensory retinal thickening.

figure bj113597.f1
Figure 1 Color fundus photograph (A) and high magnification of macula (D) demonstrates the ERM. Red‐free photograph (B). Late‐phase fluorescein angiogram shows significant ERM‐associated leakage (C). OCT with arrow pointing ...
figure bj113597.f2
Figure 2 Spontaneous resolution of ERM. Color fundus photograph (A). Red‐free photograph (B). Late‐phase fluorescein angiogram with no leakage (C). OCT with significant reduction of retinal edema (D).

Comment

Without surgical intervention, ERM is typically a stable or slowly progressive condition.4 Resolution typically has been linked to the development of a posterior vitreous detachment (PVD). Spontaneous regression has been noted in the three instances in the English‐speaking literature but with adequate colour depiction in only one instance.1,2,3 All previously published articles pertain to idiopathic macular pucker without a pre‐existing PVD. Secondary ERM, unlike idiopathic ERM, are associated with pre‐existing ocular disease such as diabetes, retinal vascular occlusion, vasculitis, trauma, vitreous haemorrhage or uveitis. Although the exact pathogenesis of ERM is not completely understood, they are composed of retinal pigment epithelial (RPE) cells, fibroblasts, vascular endothelial cells, monocytes and glial cells. Glial cells may be an important component of ERM as they produce several cytokines such as vascular endothelial growth factor (VEGF), growth factors such as fibroblast growth factor (FGF) and transcription factors as NK‐κB and AP‐1 that might stimulate inflammation and propagate the growth of secondary ERM.5 In our patient, a PVD with Weiss ring was noted at presentation in this uveitis‐related ERM. To our knowledge, we present the first photographic documentation of spontaneous resolution of an inflammatory epiretinal membrane in the presence of a pre‐existing PVD.

Footnotes

Competing interests: None.

References

1. Desatnik H, Treister G, Moisseiev J. Spontaneous separation of an idiopathic macular pucker in a young girl. Am J Ophthalmol 1999. 127729–731.731 [PubMed]
2. Greven C M, Slusher M M, Weaver R G. Epiretinal membrane release and posterior vitreous detachment. Ophthalmology 1988. 95902–905.905 [PubMed]
3. Meyer C H, Rodrigues E B, Mennel S. et al Spontaneous separation of epiretinal membrane in young subjects: personal observations and review of the literature. Graefes Arch Clin Exp Ophthalmol 2004. 242977–985.985 [PubMed]
4. Ryan S. Retina. 4th edn. Philadelphia: Elsevier, 2006. 2509–2525.2525
5. Harada C, Mitamura Y, Harada T. The role of cytokines and trophic factors in epiretinal membranes: involvement of signal transduction in glial cells. Prog Retin Eye Res 2006. 25149–164.164 [PubMed]

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