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What is an epiretinal membrane?
An epiretinal membrane or macular pucker is a condition in which a very thin layer of scar tissue forms on the macula. It feels as if a thin layer of transparent cellophane has appeared on the macula which will obviously affect a person’s vision. As the scar tissue contracts, also the underlying retina will start to crease. As a result, the retina’s photoreceptors will no longer be correctly aligned and the patient will complain of distorted vision.
These distortions are known as metamorphopsia. Patients who develop a macular pucker will complain of impaired vision either or not combined with image distortion (metamorphopsia). Sometimes, patients may report a reduction in image size. The intensity of these complaints varies greatly from patient to patient. In the early stages, the patient may not even notice anything. Other patients will see their vision deteriorate dramatically as the macula is the part of the eye that is responsible for sharp vision. Epiretinal membranes have no real cause. In the case of a secondary membrane, the cause can be attributed to a pre-existing pathology of the eye such as uveitis (internal eye inflammation), laser treatment of the retina or an earlier surgical procedure.
Epiretinal membrane: treatment
The majority of patients who develop an epiretinal membrane will not require treatment. This would be the case if vision is intact and the patient has few complaints. As a rule, the pucker won’t progress.
However, if the patient’s visual acuity deteriorates dramatically and complains of metamorphopsia (image distortion), surgery is indicated to improve and prevent the patient’s eyesight from worsening any further. An epiretinal membrane can be removed via vitrectomy.
The first step in a vitrectomy is to create 3 microscopic incisions in the eye’s sclera (= white outer layer of the eyeball). These incisions are required for the surgeon’s instruments. Via the first incision, the eye is infused with water to ensure that it retains its shape during surgery. Next, the endolight is inserted via the second incision so that the surgeon can see everything clearly. The vitrectomy probe is inserted via the third incision. This probe is a tiny tube that cuts away and suctions microscopic particles of the vitreous. The vitreous that has been removed is replaced with clear water. A blue dye is used to make the epiretinal membrane clearly visible. Next, the membrane is removed with the help of minuscule tweezers. This procedure is known by the name of ‘peeling’. Once the epiretinal membrane has been removed, the photoreceptors will be able to align themselves again, image distortion will improve and finally disappear. However, vision will improve only slowly and it can take weeks or months to return to normal.
Straight after surgery, the eye will be slightly red and sensitive. You will need to apply anti-inflammatory drops for a few weeks. After a membrane peeling, sight often restores slowly. Over a period of several months, visual acuity will improve and the metamorphopsia will reduce. In general though, sight does not recover fully. 70 to 75 % of patients attain a visual acuity of 5/10 after surgery. Some fare better and see their sight improve to 8 to 9/10. This surgical procedure is performed to improve image formation and to stop the condition from deteriorating.
However, visual acuity cannot always be restored.
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