EPIRETINAL MEMBRANE SURGERY

Epiretinal membrane (ERM) causes painless blurred vision, not to be confused with cataracts of astigmatism. Other names for this eye condition include macular pucker or cellophane maculopathy.

WHAT IS AN EPIRETINAL MEMBRANE?

The inner lining at the back of the eye is known as the retina. This part of the eye is the specialized nerve layer that transmits light signals to the brain, to be interpreted as images.

An epiretinal membrane is a very thin, semi-translucent layer of scar tissue that forms above the surface of the retina. More precisely, above the center part, called the macula.

The macula comprises special sensitive nerve cells that provide our sharp central vision needed for seeing fine detail (how far you can read down the letter chart). When an epiretinal membrane develops, it can cause the underlying macula to contract and wrinkle. This translates into distorted or blurred vision and a reduction in your visual acuity, which may slowly worsen over time. Also, straight lines or letters may look wavy or bent (metamorphopsia).

Less commonly, epiretinal membranes may also be associated with double vision, light sensitivity, or images looking larger or smaller than they actually are.

However, the epiretinal membrane isn’t painful. Also, it doesn’t cause vision loss (go blind) because it doesn’t affect peripheral vision. In fact, it may not always cause you sight problems at all.

Written by Dr Osama Bahsas Zaky
Updated on October 27, 2021

What Is an Epiretinal Membrane?

Causes and Diagnosis.

Do You Need Membrane Peeling?

The Surgical Procedure.

Surgery Aftercare and Recovery.

Is Surgery Effective?

Risks and Complications.

Surgery Cost.

WHAT ARE EPIRETINAL MEMBRANE CAUSES AND DIAGNOSIS?

In most cases, a macular pucker is related to normal age-related changes inside the eye, mainly posterior vitreous detachment (PVD).

During this process, there is an area of superficial irritation in the retina. Then, vitreous cells may be released and multiply on the retina’s surface as a healing response.

Secondary epiretinal membranes most commonly develop with risk factors, such as:

  • prior retinal detachment surgery
  • laser treatment for diabetic eye disease
  • retinal tears
  • blockage of retinal blood vessels (diabetic retinopathy)
  • inflammation (swelling) in the eye and trauma

Epiretinal membranes are not linked to age-related macular degeneration, though. Most cases affect only one eye. Roughly 10 % of idiopathic ERM’s affect both eyes. Also, they are quite common and affect up to 10% of patients in their 50s-60s or older.

There is nothing you can do to prevent this eye condition. However, the risk of secondary epiretinal membranes could be reduced in some cases by managing the underlying cause (e.g.diabetes). Whichever the cause, the macular pucker is diagnosed during a routine eye exam (slit lamp test).

Sometimes, your eye doctor may ask for a special scan of the back of the eye known as Ocular Coherence Tomography (OCT) to confirm the diagnosis and the severity of the condition. It allows evaluating the macula in cross-section and three-dimensionally.

In some patients, your eye doctor can suggest additional testing like fluorescein angiography to determine if underlying retinal problems are causing this condition.

DO YOU NEED EPIRETINAL MEMBRANE PEELING?

When deciding on the surgery, the main symptoms are blurring and distortion of vision severe enough to make it hard to perform everyday tasks, such as reading and driving.

Surgery is the only treatment for an epiretinal membrane. There are no eye drops or tablets that you can take that will help. However, suppose your macular pucker is not causing any problems with your vision, or you present with minimal distortion. In that case, your ophthalmologist may suggest just monitoring the membrane to see whether it worsens.

In many cases, as just one eye is generally affected, patients can adjust to the difference in vision.

HOW IS THE EPIRETINAL MEMBRANE SURGICAL PROCEDURE?

Epiretinal membrane surgical treatment includes both a vitrectomy and membrane peeling. The surgery involves making three small incisions of 1 mm in length, in the white of the affected eye (the sclera), to enable fine instruments to enter. Then, the jelly-like substance that usually fills the center of the eye, called the vitreous gel, is removed (vitrectomy).

The removal of the vitreous gel inside the eye will not cause any permanent harm, though. It is replaced with a specially designed salty fluid. The membrane is then physically grasped and gently peeled away from the retina using fine forceps (membrane peeling).

In some cases, a small air bubble is left in the eye at the end of the procedure to help with the healing. It acts as an internal splint to support the retina. Hence, you may notice a small shadow at the bottom of your vision that may move around. This bubble is reabsorbed by the body within one or eight weeks. During this time, you will experience blurry vision.

The incisions made in your eye should close and heal on their own (“self-sealing”), so usually, no stitches are needed. This technique allows for faster healing of the eye with minimal ocular irritation. If you get stitches, your doctor will use fine absorbable sutures.

The surgery is performed in less than one hour. It is an outpatient surgical procedure done under local anesthesia to be awake and have minimal complications from anaesthesia postoperatively.

During the surgery, you may feel pressure around the eye or see some shadows and lights. This is expected since the retina is still functioning. But you can receive a mild sedative, so you experience minimal discomfort.

In rare circumstances, a general anaesthetic is offered.

HOW IS EPIRETINAL MEMBRANE SURGERY AFTERCARE AND RECOVERY?

After the surgery, your doctor will place an eye shield on your eye. You must wear it for 24 hrs. Most patients have slight discomfort after surgery. If you experience mild pain, we recommend you take acetaminophen. But, avoid Aspirin or Ibuprofen as they can increase your risk of bleeding.

After surgery, you will need to use eye drops for up to six weeks while the eye heals. You will be advised on how and how often to use the eye drops before leaving the hospital.

These are antibiotics and steroid eye drops to prevent infection and reduce inflammation around the eye.

  • You should avoid heavy lifting and heavy exercise during the first week.
  • You should avoid getting shampoo or soap into your eye for four weeks.
  • Patient should also avoid swimming for 12 weeks.

Most patients need two weeks off work after surgery for recovery. Following surgery, the vision is typically more blurred. It will gradually improve the first 2-3 months following surgery as healing and remodeling of retinal layers occur.

Total recovery takes up to 6-12 months before the final level of vision is known.

If your doctor uses a gas bubble, you cannot lie on your back until all of the gas has been absorbed. Otherwise, your eye pressure may increase, and there is more chance of developing a cataract. It is best to keep your head propped up to help the gas bubble to do its job.

IS EPIRETINAL MEMBRANE REMOVAL EFFECTIVE?

The surgery usually improves or completely removes the effect of distortion in your vision. Most people notice this improvement in the first month following surgery.

You won’t necessarily get an improvement in reading and distance vision, though. Indeed, although most patients (75%) have improved vision, a small percentage do not experience this, even after successful and uncomplicated surgery.

The results depend on how affected your vision was before the surgery, for how long, and the degree of traction.

WHAT ARE THE RISKS AND COMPLICATIONS FROM EPIRETINAL SURGERY?

ERM surgery is a safe procedure with a good success rate. However, like any other eye surgery, it involves certain risks, such as:

  • 1 in 1000 risk of infection (endophthalmitis). This complication is very rare.
  • 1 in 1000 risk of bleeding. We will check any medications you are taking before surgery to ensure they are not blood thinners that could increase your risk of bleeding.
  • 5% risk of retinal tear or detachment. Vitrectomy surgery can cause a tear in the retina, leading to a detachment during or after surgery.
  • Progression of cataract. Most patients develop a cataract (cloudy lens) more rapidly following this type of eye surgery. This is because the internal fluid is affected and the presence of the gas in the eye.

Sometimes, a cataract may be removed simultaneously to enable a clearer view for the vitrectomy surgery to be performed.

HOW MUCH DOES EPIRETINAL MEMBRANE SURGERY COST?

Surgery cost depends on the technique performed. If you want to receive a quote, please, fill in the contact form. You can send us your recent medical reports, so we can offer you the solution that best suits your needs.

You can be sure that this information will always be treated with maximum confidentiality.

BEST EPIRETINAL MEMBRANE SPECIALISTS:

Doctor Mª José Capella Elizalde

Doctor Mª José Capella Elizalde

Graduated in Medicine (Universidad Autónoma de Barcelona, 2005). Specialization in Ophthalmology at the Barraquer Ophthalmology Centre (2006-2010). Training in the subspecialty of Uveitis and Ocular Inflammation in USA centers such as the Massachusetts Eye Research and Surgery Institution and the Bascom Palmer Eye Institute (2011). Member of the Department of Vitreous-Retina and Uveitis and Ocular Inflammation Unit at the Barraquer Ophthalmology Centre. Member of the faculty of the Graduate Program of the Universidad Autónoma de Barcelona, given by the Institut Universitari Barraquer (Master Program and Intensive Courses).
Languages: Spanish, Catalan, English, French
Association number: 40.718

Doctor Javier Elizalde

Doctor Javier Elizalde

Bachelor in Medicine and Surgery (Universidad Autónoma de Barcelona, 1990). Doctor Cum Laude in Medicine and Surgery (UAB, 2003) with National Prize Thesis. Training of specialist in ophthalmology in the MIR Barraquer Ophthalmology Centre (1991-1994). Chief of residents in 1994. Training in USA in pathology and surgery of the vitreous and retina at the Bascom Palmer Eye Institute (Miami, 1995-1998) with Dr. Donald Gass, in Columbia University (New York) with Dr. Stanley Chang, at the Vitreous Retina Macula Consultants (New York) with Dr. Lawrence Yannuzzi and in Memphis (Tennessee) with Dr. Steve Charles. Complementary Training in ocular oncology at the Wills Eye Hospital (Philadelphia) with the Drs. Jerry and Carol Shields (1999). Deputy Coordinator of the Vitreous-Retina Department. Coordinator of the Ocular Oncology Unit. Vice-president of the Academic Board of the Barraquer Institute.
Languages: Spanish, Catalan, English, French, Italian
Association number: 27.498

Doctor Sònia Viver

Doctor Sònia Viver

Bachelor of Medicine and Surgery (2001) and specialist in Ophthalmology (2006). She works at the Vitreous-Retina Department of the Barraquer Ophthalmology Centre, highlighting her work in the field of diagnosis, treatment and monitoring of Age-Related Macular Degeneration. Member of the teaching staff of the Master, Diploma courses and other Postgraduate courses organized by the Institut Universitari Barraquer (UAB).
Languages: Spanish, Catalan, English

Doctor Santiago Abengoechea

Doctor Santiago Abengoechea

Bachelor of Medicine and Surgery (University of Barcelona, 1996). Specialized in Ophthalmology (2001). Stay in the “Bascom Palmer Eye Institute” Miami (USA, 2007) with Dr. Philip Rosenfeld. Coordinator of the treatments of Age-Related Macular Degeneration (AMD) and the Optical Coherence Tomography Department.
Languages:  Spanish, Catalan, English.
Association number: 32.305

External links – Bibliography

Efficacy of Internal Limiting Membrane Flap Techniques with Vitrectomy for Macular Detachment Associated with an Optic Disc Pit. Nadal J, García-Arumí J.

Treatment of retinal detachment secondary to macular hole in high myopia: vitrectomy with dissection of the inner limiting membrane to the edge of the staphyloma and long-term tamponade. Nadal J, Verdaguer P, Canut MI.Retina. 2012 Sep

Vitrectomy and internal limiting membrane peeling for macular folds secondary to hypotony in myopes. Nadal J, Carreras E, Canut MI, Barraquer RI.Clin Ophthalmol. 2015 May 1

Internal limiting membrane translocation for refractory macular holes. Pires J, Nadal J, Gomes NL.Br J Ophthalmol. 2017 Mar

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