Epiretinal Membrane and Macular Hole
Epiretinal membranes, both with and without traction, and macular holes can occur in patients with active or inactive uveitis. They often are associated with significant vision loss. Although it makes intuitive sense to apply standard surgical therapy with pars plana vitrectomy, membrane peel, internal-limiting membrane peel, and/or gas tamponade, there is a lack of consensus on the optimal techniques, timing, and case selection for surgical therapy. Isolated cases of both conditions that have improved with maximal medical management alone have been described. It is clear that optimal control of inflammation is essential in optimizing visual results. If surgery is performed, aggressive perioperative inflammatory control is paramount. This is typically achieved with perioperative oral or local steroids. Standard vitreoretinal techniques are described in in BCSC Section 12, Retina and Vitreous. These techniques have been reported to produce favorable results in multiple case series in the treatment of epiretinal membranes and macular holes in uveitic eyes,
Branson SV, McClafferty BR, Kurup SK. Vitrectomy for epiretinal membranes and macular holes in uveitis patients. J Ocul Pharmacol Ther. 2017;33(4):298–303.
Callaway NF, Gonzalez MA, Yonekawa Y, et al. Outcomes of pars plana vitrectomy for macular hole in patients with uveitis. Retina. 2018;38(Suppl 1):S41–S48.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.