PMC4363963_01
(a and b) Colour fundus picture of the postpole of right and left eyes of case 1 showing numerous flecks in the perifoveal area and posterior pole (c) colour fundus picture of the right eye 6 years later showing a thick epiretinal membrane at the macula. (d) Postoperative colour fundus picture of the right eye showing absence of epiretinal membrane with retinal pigment epithelial atrophy at the macula
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F1
A 31-year-old-male, a diagnosed case of Stargardt disease [Fig. 1a and b] on follow-up since 6 years presented with gradual diminution of vision in the right eye since 2 months. Fundus examination revealed the presence of a thick ERM with macular edema [Fig.1c]. Postoperative period was uneventful with release of traction due to ERM [Fig. 1d] and restoration of the foveal contour on SD-OCT [Fig.2b] and unchanged autofluorescence pattern [Fig.2c and d].
(a) Preoperative Optical coherence tomography (OCT) of case 1 showing increased macular thickness secondary to thick epiretinal membrane. (b) Postoperative OCT showing restoration of foveal contour with RPE atrophy. (c) Preoperative autofluorescence image showing hypoautofluorescence corresponding to central area of retinal pigment epithelial atrophy. (d) Postoperative autofluorescence image showing no change in the hypoautofluorescent area
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F2
Spectral domain-optical coherence tomography (SD-OCT) [Fig. 2a] also documented a macular thickness of 680 mu in the right eye. 1-month later macular thickness increased to 796 mu. Postoperative period was uneventful with release of traction due to ERM [Fig. 1d] and restoration of the foveal contour on SD-OCT [Fig.2b] and unchanged autofluorescence pattern [Fig.2c and d].
PMC4363963_02
(a) Colour fundus picture of right eye of case 2 patient at 3 years follow-up showing beaten metal appearance at the macula. (b) Colour fundus picture of the left eye showing thick epiretinal membrane causing macular traction and associated with subretinal hemorrhage. (c) Colour fundus picture of the left eye 1-month later showing further increase in the macular traction with resolution of subretinal hemorrhage. (d) Postoperative colour fundus picture at 5 month follow-up showing traction relief at macula with retinal pigment epithelial atrophy
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F3
A 24-year-old myopic male, a diagnosed case of Stargardt disease [Fig. 3a] on follow-up since 3 years with a BCVA of 20/400, N36 in both eyes, presented with sudden onset metamorphopsia in the left eye of 1-week duration. Though, BCVA was unchanged, fundus showed an ERM causing traction on the macula with associated edema and subretinal hemorrhage [Fig. 3b]. On review 1-month later [Fig. 3c], BCVA reduced to 20/600, < N36. Restoration of foveal contour with retinal atrophy [Figs. 3d and 5b] and a slight increase in the hypoautofluorescence due to unfolding of the retina was noted [Figs. 5c and d].
Colour photograph and fundus fluorescein angiography (FFA) images of second patient showing the epiretinal membrane with traction and hemorrhage. FFA shows an ill defined leak from distorted capillaries, temporal to the fovea and late staining in the foveal region. No choroidal neovascular membrane can be made out
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F4
Choroidal neovascular membrane was ruled out on fundus fluorescein angiography (FFA) [Fig. 4].
(a) Preoperative optical coherence tomography picture showing increased macular thickness due to thick epiretinal membrane. (b) Postoperative optical coherence tomography picture showing restoration of foveal contour with foveal thinning. (c) Preoperative autofluorescence image showing an area of hypoautofluorescence corresponding to area of retinal pigment epithelium atrophy. (d) Postoperative autofluorescence image showing an apparent increase in the hypoautofluorescence due to unfolding of the retina
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F5
SD-OCT revealed thick ERM with a taut posterior hyaloid and increased retinal thickness of 1198 microns [Fig. 5a]. 25 g pars plana vitrectomy with ERM removal was done. Restoration of foveal contour with retinal atrophy [Figs. 3d and 5b] and a slight increase in the hypoautofluorescence due to unfolding of the retina was noted [Figs. 5c and d].