Vitreous & Retina

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Macular Diseases
OCT study of an epiretinal membrane and the color fundus photograph.

  • May occur in young people, but most commonly in elderly over the age of 50.
  • May occur in association with many ocular diseases or conditions such as posterior vitreous detachment, retinal tear or detachment, inflammatory diseases, retinopexy, trauma, intraocular surgery, scleral buckilng, diabetes mellitus and retinal vascular occlusive diseases or can be idiopathic.
  • Clinical features:
    • Symptoms:
      • Maybe asymptomatic
      • Mild distortion or decrease in vision
      • Metamorphopsia, diplopia, central photopsia and macropsia.
      • Loss of central vision
    • Signs:
      • Subtle membrane (cellophane maculopahty) appears as an irregular light reflex with indistinct border when viewed with indirect ophthalmoscopy
      • Prominent sign of epiretinal membrane: fine, superficial radiating folds of the inner retinal layers extending outward from the margin of contractile membrane
      • A large contracted membrane may cause dragging and/or increasing tortuosity of the underlying paramacular retinal vessels
      • May present as a macular "pseudohole" when the altered foveal red reflex that appears darker is surrounded by a relatively pale contracted membrane
  • May occasionally be complicated by macular hole, macular edema, hemorrhage, foveal cyst or choroidal neovascularization.
  • Fluorescein angiography demonstrates:
      • Various degree of retinal vessels tortuosity
      • Dye leakage when macular edema is present
      • Helpful in determining pseudohole from macular hole, where macular hole invariably has a central window defect
  • Management:
    • Observation if the visual acuity is 20/50 or better, or the membrane remains stable or unchanged.
    • When visual acuity is decreased and significantly interfering with the patient's daily activities, surgical intervention is usually indicated.

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