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Epiretinal Membrane:

What is epiretinal membrane?

Epiretinal membrane, also known as macular pucker, is condition where a very thin membrane forms on the surface of the retina, rather like a layer of cling-film. The membrane contracts, and forms wrinkles in the retina.

Epiretinal Membrane

Is this macular degeneration?

No, epiretinal membrane is a different condition from age-related macular degeneration (AMD).

Why does epiretinal membrane occur?

Epiretinal membranes (ERM) can form for no reason. However in some cases they may be associated with a retinal tear or previous treatment for retinal detachment, laser or cryotherapy, retinal vascular disease, uveitis or trauma.

Do I need any tests?

Usually the diagnosis can be made by clinical examination. However, sometimes Mr Charles may arrange an OCT (optical coherence tomography) scan to confirm the condition and establish how severely it is effecting the retina:

OCT Scan Before Surgery   OCT Scan afer surgery

OCT scan before surgery showing ERM

 

After surgery showing improved macular
profile and no residual ERM

Does it need treatment?

In many patients with early ERM the symptoms of distortion are very mild and the vision remains good so that treatment may not be indicated. This may remain stable for many years such that treatment is never required. However in some patients the ERM thickens and produces more symptoms of distortion and visual loss. This would be an indication for surgery.

How can epiretinal membrane be treated?

Treatment is by surgery. A pars plana vitrectomy is performed. 3 tiny holes are made in the sclera (white of the eye) and the vitreous jelly is removed, and the epiretinal membrane is very gently peeled away from the surface of the retina. If patients have co-existing cataract this can be removed at the same time.

OCT scans of epiretinal membrane before and after surgery

Do I need a general anaesthetic for surgery?

No. Mr Charles has performed this sort of surgery under local anaesthetic for many years and is very happy with the technique. However, everyone is different and some patients may prefer to have a general anaesthetic. Therefore the decision as to what kind of anaesthetic you would like is made at the time of your assessment, also bearing in mind your general health.

What happens if my epiretinal membrane is not treated?

If symptoms are very mild and you do not notice distortion, unless in occasional situations, surgery may not be required and things may remain stable. However if the symptoms get worse and the ERM is not removed, the central vision will steadily deteriorate, with increasing distortion and reducing your ability for fine tasks in that eye (ie: read, or recognise faces). The peripheral part of the vision will remain unaffected. Therefore, although the vision will become very blurred in the centre, the eye will never become totally blind. However it is the macula that gives the central, most important part of vision. Therefore we encourage patients to have epiretinal membrane removal if they have significant symptoms.

What are the risks of surgery?

In the vast majority of patients surgery is entirely uncomplicated. 80-90% of patients have good improvement in vision and reduction in distortion. However, occasionally complications can occur associated with vitrectomy. These include early cataract formation, infection, haemorrhage and retinal detachment. Mr Charles will discuss with you the risks and benefits of any surgery at your consultation.

 
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