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Sigler, Eric J. MD; Randolph, John C. MD; Calzada, Jorge I. MD

doi: 10.1097/IAE.0b013e318276e104
Original Studies

Purpose: To describe the incidence, associated factors, morphology, and visual characteristics of a series of patients with tears within an epimacular membrane (EMM).

Methods: Consecutive, prospective, observational case series of patients with EMM rip. Patients were evaluated with spectral domain optical coherence tomography, infrared photography, and fundus autofluorescence. Symptomatic patients were treated with pars plana vitrectomy and EMM removal. Follow-up imaging evaluation was performed at 3-month intervals.

Results: A total of 761 patients presented with EMM. Thirty-four eyes of 34 patients (4.5%) developed EMM rip. Frequent associated features included history of cataract extraction, diabetes mellitus, and retinal tear treated with photocoagulation. Morphologic characteristics included a scrolled torn edge of internal limiting membrane/EMM. Rip patterns include horseshoe shapes and patchy confluent striae and appeared as dark lines on infrared or fundus autofluorescence imaging. The EMM rips were classified as Type 1 if the rip occurred within 500 μm of the foveola on spectral domain optical coherence tomography and Type 2 if extrafoveal. Foveal involvement was associated with worse presenting vision (P = 0.002) and visual outcome after EMM removal (P = 0.012). Previous retinal tear was associated with worse visual outcome.

Conclusion: The EMM rip occurs in a small but significant minority of patients with EMM. Foveal involvement leads to increased visual deficit and may indicate a worse visual outcome at presentation and after intervention. Fundus autofluorescence and infrared imaging are useful in identifying EMM rip patterns.

This prospective observational case series examined consecutive patients developing tears in an epimacular membrane or “epimacular membrane rip” as evident with spectral domain OCT. We classify this clinical entity based on foveal or extrafoveal involvement, examine the imaging characteristics, and report the clinical course in those followed with observation or pars plana vitrectomy with epimacular membrane peel.

Division of Vitreoretinal Surgery, Charles Retina Institute, Memphis, Tennessee.

Reprint requests: Eric J. Sigler, MD, Charles Retina Institute, 6401 Poplar Avenue, Suite 190, Memphis, TN 38119; e-mail:

The authors have no financial or conflicts of interest to disclose.

© 2013 by Ophthalmic Communications Society, Inc.