What is an epiretinal membrane?
An epiretinal membrane (also known as cellophane maculopathy or macular pucker) is a condensation of a fibrous “membrane” on the surface of the macula. The macula is the centre of the retina where the highest visual acuity is obtained. The membrane causes the surface of the macula to become wrinkled and more opaque, like a layer of plastic wrap over a camera film. The vitreous is a jellylike substance which fills the central cavity of the eye. The vitreous gel shrinks with age in most people. As the vitreous shrinks. It pulls away from the retina (a posterior vitreous detachment or PVD). Usually this occurs without consequence. In some people the vitreous does not completely pull away and continues to contract, like a scar will contract and close. Visual acuity decreases to a level depending on how distorted the macular surface becomes. Some patients will have minimal visual distortion; others may have severe loss to the level of legal blindness. Sometimes even though the vision reading the eye chart may be quite good, the vision will still functionally be poor due to distortion (straight lines appear bent, wrinkled). The decision on whether surgery is indicated or not depends on the level of vision and the level to which this impact your quality of life.
What can be done for an epiretinal membrane?
When the vision is felt to be affected badly enough we perform a surgical procedure that involves removing the vitreous gel and associated epiretinal membrane from the eye so that it is no longer pulling on the macular and causing visual distortion.
The vitreous gel is replaced with a special balanced salt solution and gradually your body replaces it with naturally produced fluid. Sometimes an air or gas bubble is required to help flatten the retina.
Three tiny incisions are made in the eye to perform the surgery and closed with self-dissolving sutures.
What can I expect after surgery?
There is usually very little pain. Your eye will feel itchy and scratchy for the first few days. You will be putting in eyedrops four times per day for four weeks, and wearing an eye shield night for the first week. It is common for patients to experience mild irritation for a few days after surgery, but severe pain is an indication to call your surgeon immediately. The eyelids are usually swollen for the first couple of days, but this gradually resolves today after.
If you have increasing pain or significant worsening in your vision you should call the practice immediately. If it is after hours, an answering machine will direct you which cell phone number to call.
What are the risks of the procedure?
There are always risks associated with surgical procedures. A retinal detachment occurs in about 1-3 percent of patients but is usually treatable with further surgery, often with little or no adverse effect on your final vision. The intraocular pressure is transiently elevated in about 20% of patients. This is usually temporary and well controlled with eyedrops. However, the inconvenience of additional visits to the practice or medical therapies may be necessary. The most severe complications occur less frequently: the risk of severe haemorrhage, infection, irreparable retinal detachment or complications from anaesthesia occur in approximately one in several thousand cases (similar to the risk of dying in a severe car accident). Rarely double vision or eyelid droop may develop and need to be replaced with further surgery.
The most common side effect of epiretinal membrane surgery is cataract development. Cataract is a side effect of vitrectomy surgery, regardless of the underlying diagnosis. It begins to develop in almost all patients by 6 to 12 months after surgery. It usually becomes severe enough to require removal, but not always. If necessary, it can be surgically removed in the future with implantation of an intraocular lens.
What follow-up is necessary?
It is important to monitor the status of the eye following surgery. I usually see patients on day one, 1-2 weeks, 6-8 weeks, and then three or four months after surgery. These dates may be modified depending on several factors.
If you have any problems or concerns please call the practice at 021 671 5154.