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Purpose : We present two cases of macular epiretinal membrane (ERM) formation regarded as an early sign of proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment (RRD) surgery
Methods : Cases 1: A 68-year-old woman underwent pars plana vitrectomy and SF6 gas injection for macula-on inferior RRD. The visual acuity in her left eye was 20/20 with complete retinal attachment after gas loss. Two months post surgery, an opaque thick ERM around the macular area was observed. Two weeks after removal of the ERM alone, PVR leading to recurrent RRD was noted.
Case 2: A 40-year-old man underwent vitrectomy and C3F8 gas injection for macula-off superior RRD a giant tear in his right eye. Three years post RRD surgery, he started complaing of metamoropsia, due to macular ERM. The ERM was peeled off with end-grip forceps, retinal attachment was good. Recurrent retinal detachment with PVR ensued within 2 months of ERM removal.
Results : Recurrent retinal detachment with PVR after ERM peeling was observed in both patients. The intervals of retinal re-detachment after ERM removal in case 1 amd 2 were 2 weeks and 2 months, respectively. The macular ERM that developed after RRD repair had an opaque and thick membrane. Cellular proliferation above the macular surface may have caused retinal traction and stiffness. The break of balance between the ERM and the prior retinal detachment area may have permitted the retinal re-detachment with PVR, causing the reopening of a prior retinal tear or formation of a new retinal break.
Conclusion : ERM formation after vitrectomy for RRD may be regarded as an early sign of PVR. Removal of the ERM alone can lead to recurrent retinal detachment, concealing an existing tear or a new break. If ERM revmoal surgery is considered, the surgeon must carefully monitor the eye to assess the extent of ERM and peripheral retinal adhesion.
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