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Epiretinal membranes associated with diabetic retinopathy, retinal vein occlusion, cataract surgery

Invest Ophthalmol Vis Sci. 2009;50(5):2018-2023.

Issue: June 25, 2009

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Eyes with primary epiretinal membranes had significantly diminished best corrected visual acuity.

“We could not confirm previous associations of primary [epiretinal membranes] with diabetes, serum cholesterol levels or higher levels of education,” the study authors said. “Our study confirmed that secondary [epiretinal membranes] are frequently seen in eyes with a history of cataract surgery, retinal vein occlusion and diabetic retinopathy.”

The Handan Eye Study included 6,830 rural Chinese adults age 30 years or older. Retinal photographs and/or optical coherence tomography were attained in 6,565 subjects. Epiretinal membranes (ERMs) were found in 264 eyes of 221 subjects (3.4%). Primary ERMs were found in 227 eyes of 188 subjects; secondary ERMs were seen in 37 eyes of 33 subjects. ERMs were identified as cellophane macular reflex or preretinal macular fibrosis.

The prevalence of ERMs, including cellophane macular reflex and preretinal macular fibrosis individually, showed a statistically significant correlation with increased age (P < .001). Secondary ERMs were seen in 7.9% of subjects with diabetic retinopathy, 14.3% of subjects with retinal vein occlusion and 24% of subjects with previous cataract surgery.

Adjusted for age, gender and lens status, mean BCVA in eyes with primary ERMs was 0.07 logMAR lines lower than in other groups. Mean BCVA was 0.15 lines worse in eyes with preretinal macular fibrosis. BCVA was not significantly affected in eyes with cellophane macular reflex, the authors said.

This population-based study examined a large cohort of adults in rural China aged 30 years or older and discovered that 3.4 % harbored epiretinal membranes. The presence of epiretinal membranes was positively associated with increasing myopia and decreased visual acuity but surprisingly was negatively associated with cigarette smoking. Like most large, population-based studies, this one does not alter clinical practice because the results have no direct bearing on individual patients.

– Jay S. Duker, MD
OSN Retina/Vitreous Board Member