Isolated Central Epiretinal Membrane: A Rare Complication of Fovea-Sparing Internal Limiting Membrane Peeling Technique

Abstract

Purpose: To report a rare complication presenting as an isolated central epiretinal membrane (ERM) related to fovea-sparing internal limiting membrane (ILM) peeling technique.

Methods: Five patients who received fovea-sparing ILM peeling were enrolled. Postoperatively, an isolated central ERM developed. Optical coherence tomography (OCT) was used to evaluate the serial anatomic change.

Results: Among the five included patients, one patient had high myopia with foveoschisis, two patients had vitreomacular traction, and two patients had proliferative diabetic retinopathy with tractional retinal detachment and a fovea cyst. With an average of 5.80 months, OCT showed the gradual development of the isolated central ERM with severe fovea distortion. Four patients received secondary revision surgery, with improvement of the fovea contour and visual acuity.

Conclusion: The fovea-sparing ILM peeling technique may cause a rare but serious complication as the isolated central ERM, which would cause significant fovea distortion as well as visual deterioration. Timely detection and intervention is recommended to prevent further visual loss. This trial is registered with NCT04445142.

Conflict of interest statement

The authors declare that there are no conflicts of interest regarding the publication of this article.

Copyright © 2021 Yen-Chih Chen and San-Ni Chen.

Figures

Figure 1

Example of the isolated central epiretinal membrane (ERM) development after fovea-sparing internal limiting membrane (ILM) peeling technique in a case with myopic foveoschisis (case 2). (a) A 10-year-old boy had pathologic myopia and macular foveoschisis of the left eye. The best-corrected visual acuity of his left eye was 20/80. He received vitrectomy with fovea-sparing ILM peeling. (b) Postoperatively, the foveoschisis improved. (c) However, 3 months later, an isolated central fovea ERM gradually developed, and optical coherence tomography (OCT) demonstrated severe contraction of the ERM with bulging fovea contour. The central fovea thickness (CFT) was 404 µm, and his visual acuity deteriorated to 20/100. (d) 1 month later, follow-up OCT showed spontaneous peeling of the central ERM with decreased fovea distortion. The CFT improved to 204 µm, and the second revision surgery was therefore postponed.

Figure 2

Example of the isolated central epiretinal membrane (ERM) development after fovea-sparing internal limiting membrane (ILM) peeling technique in a case with proliferative diabetic retinopathy with a fovea cyst (case 5). (A) A 39-year-old male patient had proliferative diabetic retinopathy and a fovea cyst with very thin fovea tissue. He received vitrectomy due to persistent macular edema despite several antivascular endothelial growth factor injections. During vitrectomy, concerning the very thin fovea tissue, we performed fovea-sparing ILM peeling to prevent inadvertent avulsion of fovea tissue. However, after the surgery, optical coherence tomography (OCT) showed the development of isolated central ERM formation with progression 1 month (B) and 3 months (C) later. The central fovea thickness (CFT) was 569 µm, and his visual acuity deteriorated to 20/400. We arranged second surgery to remove the central ERM and residual fovea ILM. (D) After second surgery, OCT showed improvement in fovea contour. Three months after the revision surgery, the CFT improved to 440 µm, and his visual acuity was 20/100.