An epiretinal membrane (also called macular pucker) is a thin membrane that forms over part of the retina known as the macula. The macula is the most sensitive part of the retina and is crucial for sharp central vision.
Epiretinal membranes can cause gradual blurring of central vision, or visual distortion (seeing straight lines as abnormally curved or "wavy").
There are no proven preventive measures for this condition.
When we are young, the vitreous (the clear gel-like substance in the eye) is attached to the retina and macula. As we age, at some point in our lives, the vitreous will usually detach from the macula and the posterior retina, which is called a posterior vitreous detachment (PVD). PVD can cause symptoms of floaters and flashes for a few weeks, but in most cases does not cause any major problems.
In some patients, there may be some remnant vitreous gel on the macula, and some of the cells grow and form a membrane, similar to scar tissue, over the surface of the retina. Over time, these membrane cells can contract and cause the retina to wrinkle (or pucker), affecting and distorting vision.
Epiretinal MembraneOptical coherence tomography (OCT) scan showing an epiretinal membrane causing distortion of the macula
The best way to diagnose the problem is through an eye examination. Your ophthalmologist will administer eye drops to enlarge (dilate) the pupils temporarily so that they can examine the retina and macula. Usually, you will also undergo an optical coherence tomography (OCT) scan, which will provide a detailed cross-sectional image of the macula, which confirms the diagnosis of an epiretinal membrane. An OCT scan is very fast and convenient. The light beam used for scanning is painless, and unlike X-rays, does not involve any radiation.
Epiretinal membranes do not always require treatment. In many cases, epiretinal membranes are mild and may not affect vision. Such cases can be safely observed. However, in some cases, if the epiretinal membrane is severe and causes significant symptoms, then surgery may be required.
Surgery for epiretinal membranes involves a vitrectomy, a form of "keyhole" surgery that uses small instruments to enter the eye to remove the vitreous gel. This allows access to the epiretinal membrane, which can then be peeled off the retinal surface with small instruments. Occasionally, a gas bubble may be injected into the eye at the end of surgery, to replace the vitreous gel.
Epiretinal membranes can be removed surgically in the large majority of cases. Surgery helps to stabilise and prevent deterioration of vision, and in most cases also improves symptoms of blurred vision and distortion. The success of improving the vision varies from person to person and ranges from 80% to 90%. Some amount of distortion may persist, depending on how long the symptoms and epiretinal membrane have been there for, prior to surgery.
Eye drops will be dispensed after surgery and should be used as prescribed. Good eye hygiene and avoiding injury to the operated eye are important to reduce infection and problems after surgery.
Occasionally, if a gas bubble was injected, your doctor may instruct you to maintain a specific head position (usually face-down) for up to two weeks after surgery, and you would also need to avoid air travel until the gas bubble dissolves. The eye will refill naturally with fluid over time.
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