Título

SPONTANEOUS RESOLUTION OF IDIOPATHIC EPIRETINAL MEMBRANE – CASE REPORT

Introdução / Purpose

To report a case of epiretinal membrane (ERM) that evolved with spontaneous resolution during follow-up.

Material e Método / Methods

This is a descriptive study (case report) of one subject.

Resultados / Results

A 53-year old male presented with progressive visual distortion in OS for the past six months. His ocular history included mild myopia (SE=-1,50/-1,75) and a vitrectomy with internal limiting membrane peeling for a macular hole in OD. On examination, the best corrected VA was 20/400 in OD and 20/30 in OS. Fundoscopy displayed post-surgical macular status in OD and macular distortion with radial folding in OS. OCT confirmed closed macular hole in OD and epiretinal membrane in OS. A non-interventional approach with close follow-ups was deemed most appropriate. During the first 3 years of follow-up, VA and serial OCT remained stable. During the 4th year, the patient noted spontaneous visual improvement in OS (VA=20/20-1) and fundus exam improved with normal macular appearance. OCT showed ERM resolution.

Discussão e Conclusões / Discussion

Epiretinal membrane typically arises in adults over 50 years after posterior vitreous detachment, or following ocular diseases and invasive procedures. Surgical intervention is the approach of choice in cases of progressive visual deterioration. Spontaneous resolution of ERM may occur via uncertain mechanisms in 1-3% of young patients, and in less than 1% in the elderly. Since persistent ERM mostly develops in eyes with preexisting posterior vitreous detachment (PVD), it is postulated that self-peeling cases may happen as PVD lose traction and induce tissue lysis/apoptosis. We chose a conservative observation in OS after considering the poor prognosis in OD following surgery, and the possibility of an adhered hyaloid overlying ERM on OCT. As described, the patient showed impressive visual restoration, probably following PVD and ERM natural release. This rare case highlights the favorable prognosis selected patients with potential vitreous attached to ERM may present only with close clinical monitoring.

Palavras Chave

Epiretinal membrane; spontaneous peeling; internal limiting membrane