Spontaneous epiretinal membrane separation
A 68-year-old woman presented with 1–2 months of decreasing vision in her right eye. Past ocular history included bilateral radial keratotomy 16 years prior. Visual acuity (VA) was 20/60 in the right eye and 20/30 in the left eye. Anterior segment evaluation and intraocular pressures were normal. Metamorphopsia was present on Amsler grid. Posterior vitreous detachments (PVD) were noted bilaterally. SD-OCT showed an ERM bilaterally [right eye shown in []. We decided to observe the patient without surgery. Left eye VA and ERM remained stable throughout subsequent examinations. At 4 months, VA in the right eye was unchanged. SD-OCT showed spontaneous ERM separation temporal to the fovea where it remained attached []. At 7 months, VA was 20/60 in the right eye. SD-OCT showed further separation of the ERM from the fovea []. At 12 months, best-corrected VA was 20/40 in the right eye. SD-OCT showed a lamellar hole with continued separation of the ERM crossing the fovea and remaining attached nasal to the fovea [].\nSurgical removal of ERM results in visual improvement in 75-85% of eyes.[] Conservative treatment of our patient obviated the need for surgery because the ERM spontaneously peeled across the fovea. This process may have been associated with PVD observed in our patient, and supports previous similar observations.[] Non-surgical approach has been previously shown in the literature to result in improved vision in select circumstances.[] Vision improved from 20/60 to 20/40 in our patient.\nWhile ERM are known to spontaneously peel, this is a rare event and should not influence decision for surgical intervention. Conversely, monitoring spontaneous ERM peel on SD-OCT may defer surgical intervention and indicate observation for further relief of traction on the fovea.