What is this membrane?

Mon, 8 Jun 2020 20:02:02 GMT

Hello fellow imagers!

I'm reaching out to request your expertise-

Please see background information below regarding this 52 y.o male patient with VA 20/30 PHNI OS

Any thoughts regarding this membrane formation?

OD- myopic macular schisis, Cft 4ft

OS (images attached)- not myopic- has non-specific macular thickening, irregular ERM with stippled hypereflectivity. He has had this odd layer/thickening since his visits in 2017 and we found yesterday through OCT, OCT-A, and IVFA that he has probable macular telangiectasia (new fluid noted as well as right angle vessels and reflective temporal findings on multicolor imaging as well as redfree, and FAF.

The area of interest looks like it resides between the ILM and RNFL??? Disruption? Start of a larger ERM?

What do you think this is? I have seen things like it before, although not often. I'm researching it and online results not giving me a definitive answer thus far.

Any information would be most helpful!

Thank you so much!

Julia Monsonego

Thu, 11 Jun 2020 20:06:26 GMT

I've seen those as well, probably more commonly with patients who'd been diagnosed with a form of MacTel. I couldn't say what it is, but the OCT appearance of it in your images (to me) shows similarly to the Inner Nuclear Layer (had to double check the Heidelberg OCT Marketing poster).

Has the pt been treated with steroids? I'd be curious to know if its thickness changes under IVK/IVT treatments.

Tue, 16 Jun 2020 18:01:32 GMT

The layer here isn't as pronounced as your example, but this patient today reminded me of your question here. Any word back on what it is?

Mon, 22 Jun 2020 18:48:21 GMT

Hi Paul!!
Thank you for your response. I was waiting until I heard back from more people to hopefully have a better answer, but I have heard back from no one else! Even after posting on the OPS web page. I'm surprised!
Yes, I agree that membrane looks similar to the one I sent in and I have seen similar membranes in AMD. I'm thinking it may be a degenerative membrane post hyaloid detachment of some sort??? The membrane has not changed pre or post antiVEGF injections. I'll keep you posted if I hear anything else.
Thanks again! Julia

Mon, 22 Jun 2020 19:34:36 GMT

I've seen these occasionally and to my recollection they usually were in eyes that had either ERM and/or lamellar or partial thickness macular hole. My working theory has been that's it's an extension of whatever process formed the ERM in the first place (e.g. fibrous or glial proliferation). In Julia's example you can see this pt also has significant fibrous material at the ONH. In the multi-color you can see the ERM/cellophane appearance and in the 2nd and 3rd OCTs I can convince myself the foveal structure does seem as if they've been disrupted by perhaps a lamellar hole. So perhaps this eye is predisposed to a >normal fibrous proliferative response?

All that + $6 (with a mask at the drive -thru please) will get you a Starbucks.

j-

Mon, 24 Aug 2020 16:24:28 GMT

Thank you so much for your response!
I feel I'm seeing these examples more and more and believed it also had something to do with the separation of the vitreous hyaloid from the ILM as well.
Thank you for your input. It is very helpful and I will share it with the physicians.
I'll try to send you $ 6 bucks as well!!
Julia

Thu, 15 Oct 2020 20:07:42 GMT

I was going to say Mac-Tel. Defiantly by the FP it looks like mac-tel.