Epiretinal membrane surgery which removes a thin layer of scar like tissue which has formed over the macula and is distorting central vision. Usually we go to the operating room when you\’re having blurred or wavy vision which has started to impact your activities like reading or driving. We use OCT imaging to confirm the diagnosis, to assess macular distortion and to help with treatment and follow up.
What Is an Epiretinal Membrane?
An epiretinal membrane, also referred to as a macular pucker develops when a thin layer of cells and fibrous tissue grows on the retina. As the membrane shrinks it may cause wrinkling or to pull at the macula which is responsible for detail central vision.
Common epiretinal membrane symptoms are blurred vision at the center of your field of view, straight lines appearing wavy, difficulty with reading small print and variation in image size between the eyes. Some people have very mild changes which require only monitoring as opposed to epiretinal membrane surgery. A review reported that out of 49,697 people in 13 population based studies we see a standardized prevalence of about 9.1% for any epiretinal membrane. Also age is a very important risk factor.
| Finding or symptom | What it may mean | Typical next step |
| Mild distortion with good daily function | Early or stable membrane | Observation and OCT monitoring |
| Wavy lines or blurred reading vision | Macular traction | Retina specialist assessment |
| Progressive central distortion | Increasing membrane effect | Consider surgical discussion |
| Sudden flashes, floaters or shadow | Possible separate retinal problem | Urgent retinal examination |
What Does an Epiretinal Membrane OCT Show?
Epiretinal membrane OCT which uses optical coherence tomography to produce very detailed cross sectional images of the macula. The scan also shows the membrane itself, retinal wrinkling, increased retinal thickness and changes in the normal fovea shape.
More in advanced cases of epiretinal membrane OCT may see retinal layer disruption or extra inner foveal layers. These results which also help to determine the severity and what the visual recovery may look like are reported to the ophthalmologist. Thus OCT is a key tool for pre and post epiretinal membrane surgery.
Patients can also read about Vasan Eye Care’s OCT imaging guidance through the OCT eye test OCT eye test and detailed retina test retina test information.
When Is Epiretinal Membrane Surgery Recommended?
Not all membranes require that which is surgical. Mild epiretinal membrane issues may stay the same and a watch and wait approach may be right when daily life is not greatly affected. When distortion, blurred central vision or reduced visual function interferes with reading, work or driving epiretinal membrane surgery becomes a more relevant option. The decision is based on symptoms, visual acuity, examination results and epiretinal membrane OCT changes instead of any single measure.
The primary approach to the eye in cases of macular membrane is pars plana vitrectomy which includes membrane peeling. Glasses may correct for associated refractive error but will not eliminate macula traction.
What Happens During Macular Pucker Surgery?
During macular pucker surgery, the retinal surgeon performs a vitrectomy to remove the vitreous gel and gain safe access to the macula. The surgeon then carefully peels the epiretinal membrane from the retinal surface.
In selected cases, the internal limiting membrane may also be peeled. Research suggests that this may reduce membrane recurrence, although the decision depends on the individual eye and surgical approach.
| Step | Purpose |
| Pars plana vitrectomy | Removes the vitreous and provides access to the macula |
| Membrane peeling | Releases traction from the retinal surface |
| ILM peeling when indicated | May reduce the chance of recurrent membrane formation |
| Follow-up OCT | Checks macular anatomy and postoperative recovery |
More information about vitrectomy surgery is available through Vasan Eye Care’s vitrectomy surgery . The procedure forms the main surgical macular pucker treatment when symptoms are functionally significant.
What Is Recovery Like After Surgery?
Recovery from epiretinal membrane surgery is a slow process. At first vision may stay blurred and what you see may still be different from what it was preop for weeks or even months. Also it is true that full vision return to previous levels doesn’t always happen because of permanent retinal changes which may have set in by the time of surgery.
Vasan Eye Care reports on what to expect post op from a vitrectomy recovery. The National Eye Institute says that redness, swelling and blurred vision may present itself as the eye heals from a vitrectomy, also activity restrictions will vary by procedure.
After macular pucker surgery patients are given eye drops and scheduled for follow up visits which is when the surgeon will check out inflammation, eye pressure and retinal healing. Also patients are to avoid rubbing the eye and to follow the individualized advice regarding exercise, lifting and driving.
What Are the Risks and Warning Signs?
In the same way that other intraocular procedures do, epiretinal membrane surgery may present complications such as infection, retinal tear or detachment, bleeding, raised eye pressure and progression of cataract. These should be brought to your attention prior to treatment. Sudden vision loss, acute painful onset, marked redness, new flashes, dense many new eye floaters or a curtain like shadow is a cause for emergency ophthalmic assessment.
For patients which present with mild disease continuous observation is a good approach in terms of treatment. Surgery does not have to be the first option upon diagnosis of an epiretinal membrane.
Epiretinal Membrane Care at Vasan Eye Care
Vasan Eye Care provides retinal assessment, OCT imaging and surgical evaluation for macular disorders. In terms of epiretinal membrane symptoms and scan results a retina specialist can discuss options of watchful waiting, macular pucker treatment or epiretinal membrane surgery.
Patients that require in depth retinal assessment may also avail of Vasan Eye Care’s retina services, retina scan and eye exam retina scan and eye exam and macular hole diagnosis and management. That which is persistent or which is getting worse should be looked at by a doctor not just monitored at home. An ophthalmologist can determine whether observation or surgical erm eye treatment is more appropriate.
Frequently Asked Questions
1. Does every epiretinal membrane need surgery?
No. Mild epiretinal membrane symptoms may do well with a routine eye exam and epiretinal membrane OCT. When distortion or loss in central vision from the Epiretinal membrane surgery with daily activities we may recommend surgery.
2. Can vision return to normal after macular pucker surgery?
Vision does improve in most cases after macular pucker surgery, we can’t guarantee full recovery. What you end up seeing depends on how long and how severe the macular distortion was, retinal health and other eye conditions.
3. How long does recovery take after epiretinal membrane surgery?
Initial recovery from epiretinal membrane surgery takes several weeks’ time, and visual improvement may be seen for months. Also it is a variable process between patients which is why we stress that individual postoperative instructions and routine retinal follow ups are very important.
4. Is there a non-surgical macular pucker treatment?
There is no medicine to reverse an established membrane. We see that observation is a macular pucker treatment when symptoms are mild. When significant traction which affects daily vision occurs we turn to surgery as the primary and definitive treatment.
References
- Epiretinal Membrane: A Review — Clinical & Experimental Ophthalmology
https://pubmed.ncbi.nlm.nih.gov/33656784/? - Vitrectomy — National Eye Institute
https://www.nei.nih.gov/eye-health-information/eye-conditions-and-diseases/retinal-detachment/vitrectomy?