• AAO PPP Retina/Vitreous Panel, Hoskins Center for Quality Eye Care
    Compendium Type: I

    By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Panel: James C. Folk, MD,1 Ron A. Adelman, MD, MPH, MBA,2 Christina J. Flaxel, MD,3 Leslie Hyman, PhD,4 Jose S. Pulido, MD, MS, MPH,5 Timothy W. Olsen, MD6

    As of November 2015, the PPPs are initially published online-only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the journal's PPP Collection page.

    1 Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals & Clinics, Iowa City, Iowa
    2 Department of Ophthalmology and Visual Science, Yale School of Medicine, New Haven, Connecticut
    3 Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
    4 Division of Epidemiology, Department of Family, Population and Preventive Medicine, School of Medicine, Stony Brook University, Stony Brook, New York
    5 Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
    6 Emory Eye Center, Emory University, Atlanta, Georgia


    Epiretinal membranes (ERMs) are sheet-like structures that develop on the inner surface of the neurosensory retina. Vitreomacular traction (VMT) occurs when the posterior cortical vitreous partially separates from the retina yet some tractional areas remain adherent to portions of the macula and cause retinal pathology. Epiretinal membranes and VMT often occur together in the same eye. Spectral domain optical coherence tomography (SD-OCT) is a highly sensitive and routine methodology used to diagnose and characterize ERM, VMT, and associated retinal changes.

    Increasing age and other retinal pathologies (e.g., posterior vitreous detachment (PVD), uveitis, retinal breaks, retinal vein occlusions, proliferative diabetic retinopathy, and ocular inflammatory diseases) have been identified as consistent risk factors for ERM. The prevalence of ERM appears to vary by ethnicity, but the variations are not consistent across studies.

    The majority of ERMs will remain relatively stable and do not require therapy. In patients who have areas of VMT of 1500 µm or less, the incidence of spontaneous release of traction from the macula occurs in approximately 30% to 40% of eyes over a follow-up of 1 to 2 years.

    Vitrectomy surgery is often indicated in patients who are affected with a decrease in visual acuity, metamorphopsia, double vision, or difficulty using their eyes together. Vitrectomy surgery for ERM or VMT usually leads to improvement of the metamorphopsia and visual acuity. On average, approximately 80% of patients with ERM or VMT will improve by at least two lines of visual acuity following vitrectomy surgery.

    Ocriplasmin is a recombinant proteolytic enzyme that has been approved by the FDA for intravitreal injection for the treatment of symptomatic vitreomacular adhesion (VMA). It works best to release vitreous traction in younger patients (<65 years), eyes without an ERM, eyes with a full-thickness macular hole and associated VMA, phakic eyes, and eyes with a focal VMA of 1500 µm or less.4 Side effects of ocriplasmin are described in this PPP.

    (4Haller JA, Stalmans P, Benz MS, et al. Efficacy of intravitreal ocriplasmin for treatment of vitreomacular adhesion: subgroup analyses from two randomized trials. Ophthalmology 2015;122:117-22.)