BACKGROUND: Epiretinal membranes are not uncommon in healthy elderly patients, but are unusual findings in children. Epiretinal membranes result from proliferation of retinal glial cells that have gained access to the retinal surface through breaks in the internal limiting membrane. Etiologies range from retinal vascular disease, intraocular inflammation, ocular surgery, trauma, or are idiopathic. In children the most common etiology is trauma. Intervention is often based upon visual acuity. Surgical removal of the membrane may improve vision. However, complications of epiretinal membrane peeling include intraoperative hemorrhage, progressive nuclear sclerosis, retinal tears or detachments, macular edema, macular hole, hypotony and retinal pigmentary epitheliopathy.
CASE REPORT(S). A thirteen-year-old black male presented with reduced vision in the right eye that began one year following paintball trauma to that eye three years ago. Evaluation of the right eye showed best-corrected visual acuity of 20/80, angle recession with normal intraocular pressure, extensive chorioretinal scarring, posterior vitreous detachment, and epiretinal membrane with a pseudohole sufficient to explain the reduced acuity. The left eye was unremarkable. Management was directed towards prevention of further vision loss in this child. Refractive correction with polycarbonate lenses, avoidance of high impact sports, and periodic amsler grid monitoring were prescribed.
CONCLUSIONS. A common treatment for macular pucker is surgical peel of the epiretinal membrane. In pediatric cases, the risk of complications may be a greater issue when deciding whether to send a child for surgery. Although patients are often surgically treated when visual acuities fall below 20/80, one may want to be more conservative when dealing with a child. Complications such as progressive nuclear sclerosis are treated with cataract extraction in presbyopic adults, but the same treatment may result in a burden of asymmetric accommodative problems for a healthy young child. This scientific case report reviews the management considerations when treating a pediatric patient where often other methods of visual rehabilitation are required.