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Spontaneous separation of epiretinal membrane: a report of three cases

Epiretinal membranes (ERMs) develop on the surface (that is, on the internal limiting membrane) of the retina, typically at the posterior pole and the macula. ERM occurs mainly in patients older than 50 years of age and may affect both eyes in up to 13.5 per cent of cases. A mild ERM may not cause any visual symptoms. Symptomatic patients may experience blurred central vision and metamorphopsia which can significantly affect their quality of life. Treatment for symptomatic ERM using pars plana vitrectomy and membrane peeling results in significant improvement in visual symptoms in the vast majority of patients, although there are surgical risks of retinal tears, retinal detachment and endophthalmitis. Surgery is not always needed because symptoms may be minimal, spontaneous improvement may occur and delay in undertaking surgery often does not affect visual outcome. Spontaneous separation of ERM from the retina is known to occur albeit rarely, although one series found five cases out of 92 patients on follow-up for more than 36 months. Such an event may result in improvement of visual symptoms in symptomatic patients. The advent and regular use of optical coherence tomography (OCT) enables closer study of ERMs, particularly asymptomatic ones. It also readily shows when spontaneous resolution occurs. We report three cases of spontaneous separation of ERM to highlight this phenomenon.