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What
is an epiretinal membrane?
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Macular
Pucker |
An epiretinal membrane is a thin sheet of fibrous tissue
that can develop on the surface of the macular area of
the retina and cause a disturbance in vision. The retina is a clear film of very delicate tissue that lines
the inside of the back of the eye. The retina is nerve tissue that senses light that
shines into the eye and sends signals through the optic
nerve to the brain, which then processes the signals
resulting in sight. The macula is the center area of the retina that
gives us sharp central vision and reading vision. It is on this very thin, delicate macular area of
the retina that an epiretinal membrane area can develop. An epiretinal membrane is also sometimes called a
macular pucker, premacular fibrosis, surface wrinkling
retinopathy or cellophane maculopathy.
What
causes an epiretinal membrane?
In most cases an epiretinal membrane develops as a
result of cellular changes that occur spontaneously in
the back of the eye between the clear vitreous gel that
is normally present, and the macula. These changes are not due to anything the
afflicted individual has done, but are natural changes
that may become pathological in a small percentage of
people.
Normal
biological cells derived from the retina and other
tissues within the eye become liberated into the
vitreous gel and eventually settle onto the surface of
the macula. In some cases these cells may begin to
proliferate into a “membrane”. In many instances this membrane remains very mild
and does not have any significant effect on the macula
or the person's vision. In other cases however, the membrane may slowly
become more prominent, eventually creating a disturbance
in the retina that leads to visual blurring and/or
distortion in the affected eye.
In
the majority of cases an epiretinal membrane develops in
an eye with no history of a previous problem. This type of epiretinal membrane is call
idiopathic. Occasionally
however, an epiretinal membrane will develop in an eye
as a result of retinal detachment, trauma, inflammatory
disease, blood vessel abnormalities, or other
pathological conditions. These are called secondary epiretinal membranes and may have
the same effect on vision as the idiopathic type.
How
does an epiretinal membrane affect vision?
The majority of epiretinal membranes are mild and have
little or no effect on vision. However, in some cases the epiretinal membrane
may slowly grow more prominent and begin to cause
disturbance or mechanical distortion (“wrinkling”)
in the macula which may in turn lead to blurring and/or
distortion of the center portion of vision in the
affected eye. These
effects on vision may grow slowly worse over time.
An
epiretinal membrane does not make an eye go completely
blind. It
typically affects only the center area of vision and
does not cause a loss of the peripheral (side) vision.
Is
an epiretinal membrane the same as macular degeneration?
No! An
epiretinal membrane and macular degeneration are
completely different conditions affecting the retina. For information about macular degeneration please
see that specific section on the VRS website.
Is
there treatment for an epiretinal membrane?
Yes. An
epiretinal membrane can be treated with surgery. However, not all epiretinal membranes require
treatment. Treatment is unnecessary if the epiretinal
membrane is mild and having little or no effect on
vision. Only
cases in which the membrane is causing disturbing visual
symptoms require consideration of surgery.
There
is no non-surgical treatment for an epiretinal membrane.
What
is epiretinal membrane surgery like?
The surgery for an epiretinal membrane is called a
vitrectomy. This
surgery is usually done as a day (outpatient) surgery
using a local anesthesia. The surgery consists of making very small
incisions on the white part of the eye (the sclera) 3 mm
behind the edge of the cornea. While looking into the eye through a microscope
the surgeon can use a variety of very specialized
instruments placed through these incisions to work
within the eye. The
vitreous gel is first removed and replaced with a
specially designed saline solution. The surgeon can then “peel” the membrane from the surface
of the macula. At
the end of surgery very fine absorbable sutures are used
to close the incisions.
Newer
surgical techniques and instrumentation may allow the
surgeon to perform the surgery in some cases through
tiny “self-sealing” incisions that do not require
sutures. This
new technique allows faster healing of the eye with
minimal or no post-operative ocular irritation.
What
is the postoperative care like after epiretinal membrane
surgery?
A patch is worn over the eye until the morning after
surgery. Eye
drops or ointment that facilitates healing is then used
several times each day for 2-3 weeks after surgery.
Patients
can usually resume normal non-strenuous physical
activities the day after surgery. How quickly the patient can drive, return to
work, perform fine visual tasks, or engage in strenuous
activities will vary from person to person.
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