Epiretinal Membrane with Vitreomacular Traction
Dr Shashank Somani, Dr Sarang Lambat, Dr Prabhat Nangia, Dr Vinay Nangia
Suraj eye institute, 559, New Colony, Nagpur.
A male, 77 years of age, came for a routine ophthalmic examination. He had a history of ischaemic heart disease 5 years back. His best corrected visual acuity was 6/6p, N6 in right eye (OD) and 6/9, N6 in left eye (OS). Anterior segment examination showed presence of pseudophakia in both eyes (OU). Intraocular pressure recorded by Goldmann applanation tonometer was 12 mmHg in OD and 14 mmHg in OS.
The colour Fundus appearance of the RE shows an easily visible epiretinal membrane. There is also a small patch of epiretinal membrane visible in the left eye along the superotemporal arcade. However the vitreomacular traction is more prominent in the left eye. The OCT of the left eye showed vitreomacular traction which has lead to the development of a lamellar macular hole. The OCT of the right eye showed minimal vitreomacular traction which may resolve on its own and does not need an active intervention at present. There is a possibility however that should the epiretinal membrane severity increases in the RE with a resultant decrease in vision, further surgical management may need to be considered. The patient underwent pars plana vitrectomy for the LE and the traction was released.
This case demonstrates the importance of doing OCT star scan in patients of vitreomacular traction as the characteristics of the traction can be missed in a single line scan. Though the single line scans generally have a very high resolution the importance of these scans is lost if they do not pass through the area of interest. This may happen in the patients where the pathology involves the fovea as these patients may have difficulty in focussing the internal target of the OCT machine. One may also consider the possibility of using a dense scan that helps us to assess the macula in greater details and could help to avoid the chances of missing a clinically important pathological finding.
- Kumar N, Al Kandari J, Al Sabti K, Wani VB. Partial-thickness macular hole in vitreomacular traction syndrome: a case report and review of the literature. J Med Case Rep. 2010 Jan 13;4:7. doi: 10.1186/1752-1947-4-7.
- Alfredo García-Layana, José García-Arumí, José M. Ruiz-Moreno, Lluís Arias-Barquet, Francisco Cabrera-López, Marta S. Figueroa, “A Review of Current Management of Vitreomacular Traction and Macular Hole”, Journal of Ophthalmology, vol. 2015, Article ID 809640, 14 pages, 2015. https://doi.org/10.1155/2015/809640
Dr. Sarang Lambat
Suraj Eye Institute