An epiretinal membrane is a thin sheet of fibrous scar tissue which develops on the retinal lining at the back of the eye. This condition results in blurred vision or visual distortion. The condition can also be called pre-macular fibrosis, macular pucker or cellophane maculopathy. Epiretinal membrane formation may be due to the normal aging process of the eye. Alternatively, it may be due to previous trauma, surgery, inflammatory disease, retinal tear or retinal detachment.
Comprehensive assessment for patients diagnosed with epiretinal membrane involves a detailed initial examination and an OCT scan. In some cases, patients may require further investigations. This includes an OCT angiography and fluorescein angiography to determine the possible underlying cause and the health of the retina underneath the membrane.
When is surgery indicated?
When epiretinal membrane is mild and does not significantly affect your vision, no treatment is required. If it starts to interfere and distort your vision, vitrectomy microsurgery is indicated. This may be combined with cataract surgery if there is also significant cataract. Vitrectomy surgery has a 80-90% success rate in removing the scar tissue and restoring the retinal contour and improving the distortion in vision. However, some cases do not improve as much as expected, and some residual distortion and macular oedema may remain. Prognosis depends on the severity and the length of time the membrane has been present. Some epiretinal membranes remain stable while others may progress with permanent vision loss if left for long periods of time.
What are the benefits and risks of epiretinal membrane surgery?
Vitrectomy surgery is usually successful in removing the membrane and improving vision and the distortion. Some patients report continued improvement in their vision up to a year. The operation is performed as a day surgery or in-patient procedure. Some face down positioning may be required post-operatively. Additionally, in some cases, a long-acting gas bubble is required to tamponade any retinal holes or tears which are identified at the time of surgery.
While epiretinal membrane surgery has a high success rate, complications can arise even though they are rare. A cataract may develop earlier than would be expected during the normal aging process. Retinal tears, retinal detachment and macular holes may develop during or following surgery and further vitrectomy surgery would be required. Infections and haemorrhage are very rare risks but can occur with any surgery.