Case: Reduced vision

1. 1. What’s your first impression when looking at the three images?

The ERM does not cover the fovea centralis and therefore can't provide such a reduced VA

En face OCT at the ILM level, give a clear indication that it is ERM that gives the reduced VA

The reduced visual acuity can be explained from the autofluorescence image

The colour fundus scan shows foveal disturbances

2. 2. What can be said about the below OCT image?

The fovea is intact

The OCT is not centred at the fovea

We can't see VMT

The ERM lifts the retina significantly

3. 3. What’s the differential diagnosis for ERM?

Vitreomacular traction

Tractional retinal detachment

Hypertensive retinopathy

There is no differential diagnosis

4. 4. What does the two below OCT images show?

The OCT B scan of the fovea shows a full thickness hole

There is a connection between VA and sensory material you see in the fovea

This is a retinal surgery emergency

The en face OCT shows ERM, VMT, fovea schisis, the involved retina area and not a full thickness hole

5. 5. What should you tell your patient when you document epiretinal membrane?

The ERM can be surgical removed

ERMs have to be removed before vision is reduced

“It is normal aging”

Most ERMs do not affect vision

6. 6. What's correct about the surgical treatment of ERMs?

Can be treated by Ocriplasmin injection

Can be treated by YAG laser

Can be treated by pars-plana vitrectomy and intra limiting membrane (ILM) peeling

ERM can come back after it is removed

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