Secondary Epiretinal Membrane After Trabeculectomy

Luísa Vieira, MD; Ana Cabugueira, MD; Bárbara Borges, MD; Vanessa Carvalho, MD; Manuel Noronha, MD; Luis Abegão Pinto, MD, PhD; Maria Reina, MD; Marco Dutra Medeiros, MD


J Glaucoma. 2016;25(6):e576-e580. 

In This Article

Abstract and Introduction


Purpose: To determine the frequency of epiretinal membranes (ERM) in eyes with primary open-angle glaucoma subjected to trabeculectomy.

Methods: We conducted a retrospective study on patients subjected to trabeculectomy with at least a 6-month follow-up. Ophthalmologic examination and spectral-domain optical coherence tomography (SD-OCT) were analyzed. Eyes with previous surgical or laser treatments or other pathologies (other than glaucoma and ERM) were excluded.

Results: A total of 50 eyes (40 patients) were included in this study. The mean follow-up time after surgery was 27.8 months. After surgery, 9 eyes (18%) had preretinal macular fibrosis and 19 eyes (38%) had cellophane macular reflex. Of the 16 eyes with a preoperative macular SD-OCT, 3 (18.8%) developed ERM and 4 (25%) progressed from cellophane macular reflex to preretinal macular fibrosis, after surgery. The ERM frequency did not differ significantly between eyes subjected to trabeculectomy with or without the use of antimetabolites (P=0.08), or between eyes subjected to simple or combined surgery (phacotrabeculectomy) (P=0.09).

Conclusion: Trabeculectomy may predispose one to the appearance and progression of ERM. Further studies are needed to clarify this intriguing relation.


Epiretinal membrane (ERM), first described by Iwanoff in 1865,[1] is a vitreomacular interface disorder that can lead to incapacitant metamorphopsia and decreased visual acuity. ERM formation, although still incompletely understood, may result from the proliferation of glial cells, retinal epithelial cells, fibrous astrocytes, fibrocytes, and myofibroblasts after migration through focal defects in the internal limiting membrane, resulting in a thin hiperreflective layer in the vitreomacular interface.[2–7] The initial form, without foveal alteration, is called cellophane macular reflex (CMR) because of its biomicroscopic appearance and is usually asymptomatic.[2,3,6–9] In more advanced cases, the ERM contracts, inducing retina traction with consequent retinal folds and edema, which is known as preretinal macular fibrosis (PMF).[2,3,6,7,9]

Most cases are termed idiopathic and are related to increasing age; however, it has been associated with vascular retinal disorders, ocular trauma and inflammation, high myopia, cataract or retinal detachment surgeries, cryopexy, and laser procedures.[3,5–13]

Trabeculectomy, introduced by Cairns in 1968,[14] aims to reduce the intraocular pressure, when medical control is not possible, to prevent long-term optic nerve damage and maintain the quality of life. After modifications and refinements, this technique is still the standard surgical procedure of glaucoma. Vision loss reported after this procedure is due to cataract development or progression, cystoid macular edema, hypotony, and its potential sequelae and wipe-out syndrome.[15,16] To our knowledge, the prevalence of ERM after trabeculectomy is not reported in the literature.

Optical coherence tomography (OCT) is a noninvasive, noncontact, transpupillary imaging technology that provides high-resolution cross-sectional images of the retina. With advancements since it was described in 1991,[17] it is now extensively applied to ocular pathologies[18–20] and may be more sensitive than biomicroscopy to detect ERM, especially when media opacities are present.[2]

The purpose of our study was to determine the ERM frequency in eyes subjected to trabeculectomy using to OCT.