Insights Into Epiretinal Membranes:

Presence of EIFL and a New OCT Staging

Scheme
2nd year resident Byambadorj Munkhbayar
Introduction
VOLUME 175, P99-113, MARCH 2017
 Introduction

• Epiretinal membrane formation is a common retinal

condition characterized by fibrocellular proliferation at the
vitreoretinal interface.
 Introduction

OCT
• Epiretinal membranes;
• Ectopic inner foveal layers;
• Disruption of inner segment ellipsoid zone;
• Cotton ball sign.
 Introduction

OCT
• Epiretinal membranes;
• Ectopic inner foveal layers;
• Disruption of inner segment ellipsoid zone;
• Cotton ball sign.
 Gass classification

• Grade 0 (CM): Translucent membrane with no underlying

retinal distortion;
• Grade 1 (CCM): ERM associated with irregular wrinkling of
the inner retina;
• Grade 2 (MP): Opaque membrane, obscuration of
underlying vessels, and marked full-thickness retinal
distortion.
 Gass classification

• Grade 0 (CM): Translucent membrane with no underlying

retinal distortion;
• Grade 1 (CCM): ERM associated with irregular wrinkling of
the inner retina;
• Grade 2 (MP): Opaque membrane, obscuration of
underlying vessels, and marked full-thickness retinal
distortion.
 Purpose

• Describe the presence of continuous EIFL associated with

ERMs;

• Present a new OCT staging system of ERMs.

 Design

• Retrospective, multicenter, masked observational case series;

• SPSS V.15.0;

• P value <.05 was considered statistically significant.

 Methods

• Clinical charts and OCT images of 194 eyes of 172

consecutive patients diagnosed with ERMs were reviewed
and analyzed. BCVA, OCT were recorded at each visit.

2 retina specialists (Jan/01/2010-Jan/31/2016)

• Stein Eye Institute;
• Ramon y Cajal.
 Result
• 97 (56.4%) M;

• 75 (43.6%) F;

• Mean age 70.12±8.7 (36-90);

• 22 (12.8%) bilateral ERM;

• 150 (87.2%) Unilateral ERM.

 Result

• Stage 1 (43/194, 22.1%) - 20/21;

• Stage 2 (88/194, 45.4%) - 20/27;

• Stage 3 (51/194, 26.3%) - 20/42;

• Stage 4 (12/194, 6.2%) – 20/81.

 Result (OCTA)

• Stage 1 (9 eyes) – Minimal variation in FAZ size;

• Stage 2 (18 eyes) – Significantly reduced FAZ;

• Stage 3 (14 eyes) – Significantly reduced FAZ.

• Stage 4 (2 eyes) – Excluded due to poor image quality.

Stage 1
Stage 2
Stage 2
Discussion

Chronic anteroposterior,
centripetal traction by
ERM

Induce

Displacement and
reorganization of the IRL

Create

Ectopic inner foveal

layers
Baseline
ERM with anatomic signs
 Results

• 131 (67.5%) monitored 22.2±18.3 months (3-84 months);

• 63 (32.5%) directly scheduled surgery after first visit;

• EIFL 63/194 (32.5%).

 Conclusions

• Presence of continuous EIFL in ERMs associated with

significant vision loss and essential element of a novel OCT-
based grading scheme of ERMs that may influence visual
prognosis.
“The thing that is important is
the thing that is not seen.”
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