Age-related Cellular Proliferation at the Vitreoretinal Juncture

Clinical and pathological features of non-vascularised epiretinal membranes are reviewed with special attention to focal epimacular tractional lesions in the elderly. The role of immunohistochemistry in elucidating the nature of component cells of complex epiretinal membranes is emphasised. Clinicopathological correlation establishes the 'fibroglial membrane' as the causative lesion of age-related epimacular traction. The pathogenesis of this process is discussed, including relevant animal models, and chronic inflammation and ischaemia (rather than acute posterior vitreous detachment) are implicated. Vitrectomy and epimacular membrane peeling results in significant visual improvement in most patients.