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Epiretinal 1. How is epiretinal membrane (ERM) best diagnosed? 2. - PDF document

Aug 30, 2023 •238 likes •340 views

7/13/18 Financial Disclosure: Nothing to Disclose Learning Objectives Epiretinal 1. How is epiretinal membrane (ERM) best diagnosed? 2. How is ERM differentially diagnosed from central serous Membrane retinopathy and cystoid macular edema?

  1. 7/13/18 Financial Disclosure: Nothing to Disclose Learning Objectives Epiretinal 1. How is epiretinal membrane (ERM) best diagnosed? 2. How is ERM differentially diagnosed from central serous Membrane retinopathy and cystoid macular edema? 3. Which ERM cases can be monitored, and which will need surgical Update intervention? 4. What are the expected outcomes of macular peel microsurgery for ERM? Victoria Conference 2018 5. Which symptoms are expected to remain after successful James Kundart OD MEd FAAO surgery, and will need optical treatment? Images from FCOVD-A Cirrus OCT Pacific University College of Optometry Case Study #1, First Visit: Case Study #1: Macular Cube OCT 2014 Macular Cube OCT , 2014 -6.00 SE OD, OS BP 175/113 BCVA BMI 23 20/60 OD, OS Images from Cirrus OCT Images from Cirrus OCT Case Study #1, Second Visit: Case Study #1: 10-2 Matrix Visual Fields 2014 Macular Cube OCT 2015 Images from Humphrey Matrix Images from Cirrus OCT 1

  2. 7/13/18 BCVA 20/50 Case Study #1, Third Visit: OD, OS Macular Cube OCT Spring 2016 Case Study #1 5-Line Raster OCT 2015 BP 166/84 BMI 23 BCVA 20/60 OD and OS Images from Cirrus OCT Images from Cirrus OCT Case Study #1: Case Study #1: Macular Cube OCT Spring 2016 5-Line Raster Macular OCT Spring 2016 Images from Cirrus OCT Images from Cirrus OCT Case Study #1: Case Study #1: Corneal Topography and Macular Cube OCT Summer 2016 10-2 Matrix Visual Fields 2016 Images from Cirrus OCT Images from Medmont Topographer and Humphrey Matrix 2

  3. 7/13/18 Case Study #1: Before ERM Peel/Vitrectomy Case Study #1: Post-Op Peel OS 5-Line Raster OCRT 2017 BCVA BCVA 20/50 20/70 OD, OS OD, OS Images from Cirrus OCT Case Study #1, Last Visit: Case Study #1: Post-Op Peel OS 10-2 Matrix Visual Fields and Summary BCVA 20/50 OD, OS BP 130/88, BMI 22 Other Causes of ERM: Other Causes of ERM: Adult-Offset Adult-Offset Coats’ Disease Pre-Op Coats’ Disease Post-Op (Peel/Vitrectomy) • “(a) Color fundus photograph of the right eye of a 38-year- old man with epiretinal membrane along supertemporal arcade • (b) Ultra-wide-field color photograph showing exudation and telangiectatic vessels in temporal periphery.” • The patient was 20/25 OD with metamorphopsia OD https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678313/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678313/ 3

  4. 7/13/18 Other Causes of ERM: Eales Disease Other Causes of ERM: Eales Disease • (a) Fundus photograph and (b) fluorescein angiogram of a 22-year-old male with Eales disease Stage 3A and best-corrected visual acuity 0.1 showing fibrovascular proliferation at the disc • (c) spectral domain optical coherence tomography showed cystoid macular edema • (j) spectral domain optical coherence tomography showed epiretinal membrane and macular edema https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859602/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859602/ Epiretinal Membrane Differential Diagnoses: ERM DDx: Cystoid Macular Edema (CME) Cystoid Macular Edema (52 YOM and 13 YOF) Using NSAIDs Post-Cataract Surgery http://www.ojoonline.org/article.asp?issn=0974- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5319126/ 620X;year=2012;volume=5;issue=3;spage=187;epage=188;aulast=Garoon ERM DDx: Cystoid Macular Edema (CME) Where ERM Comes From: Do Steroids Help? Latanoprost, CME, and ERM Optical coherence tomography images of A. Optical coherence tomography of right eye before latanoprost administration. No pathology is cystoid macular edema (CME) detected. • Top: Preoperative and postoperative B. Seven months after treatment with findings of definite CME preservative free latanoprost optical coherence tomography in right eye revealed cystoid macular • Middle: Preoperative and postoperative edema with well-defined, intraretinal cystic areas findings of probable CME of low reflectivity in the macula with serous retinal detachment • Bottom: Preoperative and postoperative C. Two months after latanoprost discontinuation (cataract surgery) findings of possible optical coherence tomography demonstrated CME complete resolution of cystoid macular edema A subtle epiretinal membrane is noted https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5636715/ 4

  5. 7/13/18 ERM DDx: Does Latanoprost Cause CME? (after cataract surgery OD) Niacin and CME https://www.ncbi.nlm.nih.gov/pmc/articles/P MC5360021/pdf/13104_2017_Article_2448.pdf http://www.hindawi.com/journals/criopm/2013/713061/ ERM DDx: Microcystic Macular Edema ERM DDx: Microcystic Macular Edema (MME) • An example of a normal retina compared with the retina of a patient with MME. (A) A normal retina from a healthy control subject • The pseudo-colored surface image is the infrared surface photo; the vertical stacked gray image an OCT B-scan • (B) Optical coherence tomography image taken from a 76-year-old woman with a 3- year history of AMD, for which she received regular injections with ranibizumab and bevacizumab • At time of imaging, her best corrected VA OS was 0.7 (20/30) http://iovs.arvojournals.org/article.aspx?articleid=2190200 http://iovs.arvojournals.org/article.aspx?articleid=2190200 ERM DDx: Microcystic Macular Edema (MME) ERM DDx: Microcystic Macular Edema • Representative OCT images of patients with MME from the • (D) Microcystic macular edema in clinical spectrum are shown a 58-year-old female patient with • The infrared surface photo and OCT image are presented to the a newly diagnosed pucker in the left and the manually segmented INL to the right right eye (VA OD 0.2 or 20/100) (A) Microcystic macular edema in the right eye of a 70-year-old • Again, there were multiple male patient with a history of proliferative diabetic retinopathy hyperreflective spots in the inner treated with panretinal photocoagulation (VA OD 0.3 or 20/60) retinal layers (B) Optical coherence tomography image showing MME 8 months after occlusion of the vena temporalis superior OD in a 66-year- • (E) Microcystic macular edema 3 old female patient (VA OD 0.7 or 20/30) months after vitrectomy, in a 71- • Microcystic macular edema was located in the temporal year-old female patient with a superior quadrant of the inner 3-mm EDTRS grid retinal detachment in the left • However, INL thickening extended to the periphery. In addition, eye (VA OS 0.05 or 20/400) hyperreflective spots were observed in all inner retinal layers http://iovs.arvojournals.org/article.aspx?articleid=2190200 http://iovs.arvojournals.org/article.aspx?articleid=2190200 5

  6. 7/13/18 ERM DDx: Microcystic Macular Edema ERM DDx: Microcystic Macular Edema Propensity for the Nasal/Temporal Quadrants • Microcystic macular edema in a patient with multiple • Most frequently, MME sclerosis and a history of optic neuritis and branch was observed in patients retinal vein occlusion in the right eye with ARMD (27.1%) • This 55-year-old female patient was diagnosed with followed by patients clinical definite MS in 1992 with preceding • Magnetic resonance imaging showed multiple periventricular brain lesions, and spinal T2 ophthalmic surgery hyperintense lesions (20.3%) or presence of • In 2001, she experienced one episode of optic neuritis an epiretinal membrane OD; coincidentally, an occlusion of the vena temporalis (18.8%) superior was found (VA 0.4 or 20/50) http://iovs.arvojournals.org/article.aspx?articleid=2190200 http://iovs.arvojournals.org/article.aspx?articleid=2190200 Last ERM DDx: Case Study #2 Case Study #2: Optic Nerve Head OCT • A 62-year-old male first reported to our clinic with a chief concern was a larger image size OS • The patient had no history of eye surgery of any sort • There was a history of blunt trauma to the right nasal canthus almost 40 years Images from Cirrus OCT previously • The patient reported that he was generally healthy with a history of hay fever https://journals.lww.com/optvissci/Abstract/2018/03000/ Retinal_Nerve_Fiber_Layer_Thickness_in_Various.11.aspx Case Study #2: Optic Nerve Head OCT Case Study #2: Optic Nerve and RNFL Compare OD to OS Images from Cirrus OCT Images from Cirrus OCT 6

  7. 7/13/18 Case Study #2: Optic Nerve OCT Case Study #2: Retinal Nerve Fiber Layer OCT Images from Cirrus OCT Images from Cirrus OCT Case Study #2: Nerve Fiber Layer Analysis Case Study #2: Optic Nerve OCT Summary Images from Cirrus OCT Images from Cirrus OCT Case Study #2: Matrix N-30-5 Case Study #2: Screener is Unremarkable 24-2 SITA Standard Visual Fields • Why did we run a frequency-doubling visual field screening? • There are two reasons: both related to cranial nerves • Which two nerves were we checking with his screening field? Images from Humphrey Matrix 7

  8. 7/13/18 Case Study #2: Case Study #2: Assessment & Initial Plan Pachymetry with Ant Seg OCT http://cdn.iofferphoto.com/img3/item/568/007/701/o_xalatan- http://opticaldiagnostics.com/info/aniseikonia.html eye-drops-latanoprost-0-005-anti-glaucoma-3932.jpg Images from Cirrus OCT Case Study #2, Second Visit: Case Study #2: Macular OCT OD and OS Contact Lens Telescope and New discovery https://www.flonase.com/allergies/is- http://gogadgetplus.blogspot.com/2014/02/ flonase-a-nasal-steroid-spray/ terminator-telescopic-contact-lens.html Images from Cirrus OCT Case Study #2, Visit 1: Macular OCT OU Case Study #2, Second Visit: Macular OCT OD Images from Cirrus OCT Images from Cirrus OCT 8

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