Spontaneous separation of epiretinal membrane in young subjects: personal observations and review of the literature

Background: Idiopathic epiretinal membranes (ERM) grow on the surface of the internal limiting membrane (ILM) and are a very uncommon condition in young subjects. Methods: We report six young subjects with ERM and describe the spontaneous separation of the membranes. The functional and anatomical recovery was assessed by Snellen visual acuity, Amsler grid and funduscopy. Selected cases were additionally assessed by optical coherence tomography (OCT). Results: All subjects initially claimed a sudden, unilateral, reduction in visual acuity (VA) with severe distortion at the age of 15-30 years. No ocular trauma or disease was ascertained in any case. Initial fundus examination demonstrated a gray-whitish ERM with translucent stress lines over the macula. Visual recovery occurred in all cases after resolution of the ERM. Sequential OCT demonstrated the successive peeling of an ERM accompanied by normalization of foveal thickness. Conclusions: Young subjects should be counseled about the favorable prognosis for maintaining good vision and possible spontaneous membrane separation. Conservative observation is advocated if the visual disturbance is located temporally, as functional recovery and spontaneous membrane separation may occur. When the contracting forces of the immature ERM are stronger than its adhesions to the retina, the membrane may separate spontaneously.