What is the #1 cause of an Epiretinal membrane (ERM)?

What is the #1 cause of an Epiretinal membrane (ERM)?

• A. Vitreous traction
• B. Retinal detachment
• C. Diabetic retinopathy
• D. Macular edema

Answer: (A)

Vitreous traction on the macula is the main driver. When the posterior vitreous cortex remains abnormally adherent to the retinal surface, especially during or after a posterior vitreous detachment, it exerts tangential pulling on the macula. This traction stimulates glial and other cells to proliferate on the inner limiting membrane, forming a fibrocellular membrane that sits on the retinal surface—an epiretinal membrane. Over time, this membrane can contract and distort the macula, causing metamorphopsia and decreased vision. Diabetic retinopathy or macular edema can be associated with ERMs and may contribute to their development, but they are not the primary initiating trigger. Retinal detachment involves different processes at the retina–vitreous interface and is not the typical cause of an ERM.

Vitreous traction on the macula is the main driver. When the posterior vitreous cortex remains abnormally adherent to the retinal surface, especially during or after a posterior vitreous detachment, it exerts tangential pulling on the macula. This traction stimulates glial and other cells to proliferate on the inner limiting membrane, forming a fibrocellular membrane that sits on the retinal surface—an epiretinal membrane. Over time, this membrane can contract and distort the macula, causing metamorphopsia and decreased vision.

Diabetic retinopathy or macular edema can be associated with ERMs and may contribute to their development, but they are not the primary initiating trigger. Retinal detachment involves different processes at the retina–vitreous interface and is not the typical cause of an ERM.