preretinal fibrosis

Preretinal Fibrosis: A Condition Affecting the Retina

Preretinal fibrosis, also known as epiretinal membrane or macular pucker, is a condition characterized by the proliferation of glial cells over the surface of the internal limiting membrane of the macular region of the retina. This leads to the formation of a thin, transparent film on the vitreal surface of the retina.

Causes and Symptoms

The exact cause of preretinal fibrosis is not always clear, but it can occur as a result of aging of the vitreous gel, which over time shrinks and causes traction on the retina. This can lead to symptoms such as blurred or distorted vision, both for distance and reading.

In some cases, preretinal macular fibrosis may be caused by prior ocular surgery or disease, with cataract extraction being a common surgical cause [9]. The condition can occur in one or both eyes and is often associated with the proliferation of glial cells over the surface of the internal limiting membrane of the macula.

Characteristics

The preretinal fibrosis membrane can be semi-translucent and may obscure the underlying retinal details, causing retinal folds and traction lines that impair vision and cause metamorphopsia [13]. Fundoscopy reveals a thin film on the vitreal surface of the retina, which can be associated with marked loss of vision.

Other Names

Preretinal fibrosis has been variously termed as epiretinal membrane, preretinal gliosis, cellophane maculopathy, or macular pucker [14]. It is a common condition in its early form and can manifest as a glistening reflex on the surface of the retina.

References

• [11] Pre-retinal fibrosis may occur in one or both eyes.
• [12] A membrane on the vitreal surface of the retina resulting from the proliferation of one or more of three retinal elements: (1) fibrous astrocytes; (2) fibrocytes; and (3) retinal pigment epithelial cells.

Preretinal Fibrosis Signs and Symptoms

Preretinal fibrosis, also known as epiretinal membrane or macular pucker, is a condition that can cause various symptoms affecting the eyes. The severity of these symptoms can vary widely among individuals.

• Blurry vision: One of the most common symptoms of preretinal fibrosis is blurry vision, which can be mild or severe depending on the extent of the condition [4][5].
• Distorted vision: In some cases, preretinal fibrosis can cause distorted vision, where straight lines appear wavy or irregular [3][6].
• Small flickers or flashes of light: Some people may experience small flickers or flashes of light in their vision due to preretinal fibrosis [8].
• Pain: In rare cases, preretinal fibrosis can cause pain in the eye, although this is not a common symptom [10].

It's essential to note that these symptoms can be mild and may not significantly impact daily life. However, if left untreated or if the condition progresses, it can lead to more severe vision problems, including blindness or half-vision [10]. If you experience any of these signs and symptoms, it is crucial to consult an eye care professional for proper evaluation and treatment.

References: [3] Context result 3 [4] Context result 4 [5] Context result 5 [6] Context result 6 [8] Context result 8 [10] Context result 10

Diagnostic Tests for Preretinal Fibrosis

Preretinal fibrosis, also known as epiretinal membrane (ERM), can be diagnosed using various tests to assess the extent of the condition and its impact on vision. Here are some diagnostic tests used to diagnose preretinal fibrosis:

• Amsler Grid Testing: This test is commonly used to detect irregularities in the macula, which can be a sign of preretinal fibrosis. The Amsler grid consists of a series of horizontal and vertical lines that help identify any distortions or blind spots in vision [5].
• Fluorescein Angiography: This test involves injecting a fluorescent dye into the bloodstream, which highlights the blood vessels in the retina. It can reveal characteristic tortuosity (twisting) of retinal vessels associated with preretinal fibrosis [5].
• Optical Coherence Tomography (OCT): OCT is a non-invasive imaging test that uses low-coherence interferometry to produce high-resolution images of the retina. It can help diagnose preretinal fibrosis by visualizing the epiretinal membrane and its impact on retinal morphology [14].
• Digital Retinal Photos: High-quality digital retinal photos can be used to assess the extent of preretinal fibrosis and monitor any changes over time.
• Fundus Images: Fundus images, which are photographs taken through a dilated pupil, can also be used to diagnose preretinal fibrosis by visualizing the epiretinal membrane and its impact on retinal morphology [13].
• Best Corrected Visual Acuity (BCVA): BCVA is a measure of visual acuity that takes into account any corrective lenses or devices. It can help assess the impact of preretinal fibrosis on vision.

These diagnostic tests are essential in evaluating the extent of preretinal fibrosis and determining the best course of treatment, which may include surgery to remove the epiretinal membrane [14].

Treatment Options for Preretinal Fibrosis

Preretinal fibrosis, a condition characterized by the proliferation of glial cells over the internal limiting membrane of the macular region of the retina, can be challenging to treat. While there are no specific drugs that directly target preretinal fibrosis, various treatments have been explored to manage this condition.

Steroids and Immunomodulatory Agents

Systemic steroids and immunosuppressive agents such as azathioprine, methotrexate, cyclophosphamide, and mycophenolate mofetil are commonly used to treat preretinal fibrosis (1, 13). These medications can help reduce inflammation and slow down the progression of the disease.

Vitrectomy Surgery

In some cases, vitrectomy surgery may be performed to remove the premacular fibrotic membrane as an outpatient procedure under local anesthesia (6, 8). This surgical approach can help alleviate symptoms such as vision distortion and blurriness.

Nd:YAG Membranotomy

Another treatment option is Nd:YAG membranotomy, which involves puncturing the membrane that confines the blood vessels in the retina (8). This procedure can help improve vision by reducing the amount of fibrotic tissue.

Fenofibrate and PPARα Agonists

Research has also explored the use of fenofibrate, a specific peroxisome proliferator-activated receptor alpha (PPARα) agonist, to control blood lipid levels and potentially treat preretinal fibrosis (14). However, more studies are needed to confirm its efficacy.

Cell-Based Therapies

Additionally, cell-based therapies have been investigated for the treatment of diseases related to retinal fibrosis/gliosis (12). These innovative approaches aim to repair or replace damaged tissue in the retina.

It is essential to note that each patient's condition may vary, and a comprehensive treatment plan should be tailored to their specific needs. Consultation with an eye specialist or a healthcare professional is recommended for personalized guidance on managing preretinal fibrosis.

References:

1. (11) - Azathioprine and other immunosuppressive agents
2. (13) - Steroids and immunomodulatory agents
3. (6) - Vitrectomy surgery
4. (8) - Nd:YAG membranotomy
5. (14) - Fenofibrate and PPARα agonists
6. (12) - Cell-based therapies

Differential Diagnosis of Preretinal Fibrosis

Preretinal fibrosis, also known as epiretinal membrane (ERM), is a condition characterized by the proliferation of glial cells over the surface of the internal limiting membrane of the macular region of the retina. When considering differential diagnosis for preretinal fibrosis, several conditions should be taken into account.

• Epimacular membrane (ERM): Also known as macular pucker or cellophane maculopathy, ERM is a pathologic tissue formed at the junction of the vitreous body and the retina – the vitreoretinal interface. [13]
• Surface-wrinkling retinopathy: This condition can mimic an epiretinal membrane (ERM) in its clinical appearance. [10]
• Cellophane maculopathy: A synonym for ERM, cellophane maculopathy is a pathologic tissue formed at the junction of the vitreous body and the retina – the vitreoretinal interface. [13]
• Pre-retinal macular fibrosis: This condition can occur in one or both eyes and is characterized by the proliferation of glial cells over the surface of the internal limiting membrane of the macular region of the retina. [3]

Other conditions that may be considered in differential diagnosis for preretinal fibrosis include:

• Early nuclear cataract: Some patients with suspected early preretinal macular fibrosis have been found to have early nuclear sclerosis with some lenticular astigmatism in the visual axis. [11]
• Congenital preretinal fibrosis: This rare retinal lesion has a distinct differential diagnosis. [11]

It's essential to note that the clinical appearance of an epiretinal membrane (ERM) can be clearly remarkable, but some conditions may mimic it. Therefore, a thorough evaluation and consideration of these differential diagnoses are necessary for accurate diagnosis.

References: [3] - The condition described in this reference is preretinal macular fibrosis. [10] - This reference describes the clinical appearance of ERM and its similarity to surface-wrinkling retinopathy. [11] - Early nuclear cataract and congenital preretinal fibrosis are mentioned as differential diagnoses for preretinal fibrosis in this reference. [13] - Epiretinal membrane (ERM), macular pucker, myofibroblasts, pre-macular fibrosis, retina, and cellophane maculopathy are discussed in this reference.