Sunrays epiretinal membrane

Aim: To report a unique aspect of an opalescent, symmetrical, sun rays like epiretinal membrane (ERM), assessed with swept source optical coherence tomography (SS‐OCT). Methods: Patient was assessed with multimodal imaging: colour photography and SS‐OCT with B‐scan and en face imaging. Results: A 65‐year‐old male with hypertension and diabetes history, followed in our consultation for pre‐proliferative diabetic retinopathy (DR), lost of sight for two years, presented with progressive visual decrease in his left eye (LE). Best corrected visual acuity (BCVA) of the right eye was 8/10 without any sign of DR activity on fundus examination. BCVA of the LE was limited to hand motion. Anterior segment examination was unremarkable. Fundus examination highlighted the presence of opaque dense ERM lining the posterior pole mimicking a symmetrical wheel spoke or sunrays, centred by a foveal pigmented lesion. En face SS‐OCT showed patterned retinal folds and B‐Scan SS‐OCT showed a thick hyperreflective layer above the internal limiting membrane (ILM) associated to underlying retinal surface wrinkling. We also noted thickened disorganized retinal layers, ectopic inner foveal layers (EIFL) and loss of the foveal depression. The central bouquet assessed the presence of subretinal hyperreflective vitelliform‐like deposit associated to intraretinal hyperreflective foci corresponding to pigment migration. Conclusion: This case corresponds to the final stage ERM of Govetto classification. It reveals a migration process of retinal pigment cells towards inner retinal layers. The advent of high‐resolution SS‐OCT offered a better detection of ERM stages and alterations of the central bouquet, in order to improve our pathophysiological understanding. In fact, many hypotheses on ERM development processes were suggested. Glial cells and retinal pigment epithelial cells would undergo trans‐differentiation to a myofibroblastic pre‐retinal cells through the retina, via microdefects above ILM. Accumulated myofibroblastic cells, along with extracellular matrix deposition are the main precursors of ERM.