Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull

Ahmad M Mansour,1,2 Hana A Mansour,3 J Fernando Arevalo4,5 1Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon; 2Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 3Department of Biology, American University of Beirut, Beirut, Lebanon; 4Retina...

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Autores principales:	Mansour AM, Mansour HA, Arevalo JF
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/530f52636ccc471090bf2498a52e851d
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spelling	oai:doaj.org-article:530f52636ccc471090bf2498a52e851d2021-12-02T06:07:54ZSpontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull1177-5483https://doaj.org/article/530f52636ccc471090bf2498a52e851d2014-11-01T00:00:00Zhttp://www.dovepress.com/spontaneous-release-of-epiretinal-membrane-innbspanbspyoung-weight-lif-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483 Ahmad M Mansour,1,2 Hana A Mansour,3 J Fernando Arevalo4,5 1Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon; 2Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 3Department of Biology, American University of Beirut, Beirut, Lebanon; 4Retina Department, The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; 5Retina Department, Wilmer Eye Institute, The Johns Hopkins University, Baltimore, MD, USA Abstract: This patient presented for surgery at the age of 32 years, 14 months after his initial complaint of metamorphopsia and visual loss in the right eye. Past tests demonstrated a whitish epiretinal membrane (ERM) with translucent stress lines over a thickened macula. Visual acuity was found on last presentation to be normal with minimal alteration on Amsler grid testing. A torn ERM was found in the center with left-over ERM temporally and rolled-over ERM nasally at the site of the epicenter with no posterior vitreous detachment. Visual recovery occurred gradually over several days 2 months prior to presentation apparently following heavy weight-lifting with a sensation of severe eye pressure. Sequential funduscopy and optical coherence tomography scans demonstrated the peeling of an ERM accompanied by normalization of foveal thickness. Valsalva maneuver had put excessive tension on ERM which tore in its center at the weakest line with gradual contraction of the ERM away from the fovea towards the peripapillary area. This is a new mechanism of self-separation of ERM induced by Valsalva. ERM in young subjects is subject to rupture and subsequent separation by tangential traction. There are three mechanisms for spontaneous separation of ERM: 1) posterior vitreous detachment with pulling of ERM by detaching vitreous (most common in adults); 2) the contracting forces of the immature ERM become stronger than its adhesions to the retina resulting in slow tangential traction on the edges of the ERM and gradual separation from the edges towards the center (remodeling common in youngsters); and 3) acute tearing of ERM at its weakest central point and retraction of part of the membrane towards the epicenter (current case report). Keywords: valsalva maneuver, posterior vitreous detachmentMansour AMMansour HAArevalo JFDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2014, Iss default, Pp 2243-2250 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Mansour AM Mansour HA Arevalo JF Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull
description	Ahmad M Mansour,1,2 Hana A Mansour,3 J Fernando Arevalo4,5 1Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon; 2Department of Ophthalmology, American University of Beirut, Beirut, Lebanon; 3Department of Biology, American University of Beirut, Beirut, Lebanon; 4Retina Department, The King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; 5Retina Department, Wilmer Eye Institute, The Johns Hopkins University, Baltimore, MD, USA Abstract: This patient presented for surgery at the age of 32 years, 14 months after his initial complaint of metamorphopsia and visual loss in the right eye. Past tests demonstrated a whitish epiretinal membrane (ERM) with translucent stress lines over a thickened macula. Visual acuity was found on last presentation to be normal with minimal alteration on Amsler grid testing. A torn ERM was found in the center with left-over ERM temporally and rolled-over ERM nasally at the site of the epicenter with no posterior vitreous detachment. Visual recovery occurred gradually over several days 2 months prior to presentation apparently following heavy weight-lifting with a sensation of severe eye pressure. Sequential funduscopy and optical coherence tomography scans demonstrated the peeling of an ERM accompanied by normalization of foveal thickness. Valsalva maneuver had put excessive tension on ERM which tore in its center at the weakest line with gradual contraction of the ERM away from the fovea towards the peripapillary area. This is a new mechanism of self-separation of ERM induced by Valsalva. ERM in young subjects is subject to rupture and subsequent separation by tangential traction. There are three mechanisms for spontaneous separation of ERM: 1) posterior vitreous detachment with pulling of ERM by detaching vitreous (most common in adults); 2) the contracting forces of the immature ERM become stronger than its adhesions to the retina resulting in slow tangential traction on the edges of the ERM and gradual separation from the edges towards the center (remodeling common in youngsters); and 3) acute tearing of ERM at its weakest central point and retraction of part of the membrane towards the epicenter (current case report). Keywords: valsalva maneuver, posterior vitreous detachment
format	article
author	Mansour AM Mansour HA Arevalo JF
author_facet	Mansour AM Mansour HA Arevalo JF
author_sort	Mansour AM
title	Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull
title_short	Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull
title_full	Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull
title_fullStr	Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull
title_full_unstemmed	Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull
title_sort	spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/530f52636ccc471090bf2498a52e851d
work_keys_str_mv	AT mansouram spontaneousreleaseofepiretinalmembraneinnbspanbspyoungweightliftingathletebypresumedcentralruptureandcentrifugalpull AT mansourha spontaneousreleaseofepiretinalmembraneinnbspanbspyoungweightliftingathletebypresumedcentralruptureandcentrifugalpull AT arevalojf spontaneousreleaseofepiretinalmembraneinnbspanbspyoungweightliftingathletebypresumedcentralruptureandcentrifugalpull
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Spontaneous release of epiretinal membrane in&nbsp;a&nbsp;young weight-lifting athlete by presumed central rupture and centrifugal pull

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Spontaneous release of epiretinal membrane in a young weight-lifting athlete by presumed central rupture and centrifugal pull