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Good Hope Hospital Eye Clinic
 

Epiretinal membrane                      David Kinshuck

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Explanation

Epiretinal membrane ('ERM') formation is also called cellophane maculopathy or macular pucker. It is not a type of macular degeneration.

The central part of the retina is affected. A very thin film or membrane develops on the surface of the retina. This membrane, very like 'cling-film', starts to shrink, and this causes wrinkling of the retina.

The wrinkling may be mild, in which case surgery is not recommended. In such a patient the sight would be good or reasonable, and stable and not getting worse.

 

Vision

The vision can be affected in various ways. Central vision can be reduced, causing generally blurred vision. Alternatively, images may appear bent or wavy.

If the sight does get worse and the wrinkling increase, then surgery may be recommended. Only ~15% people notice an increase in the wrinkling, and their sight will deteriorate over months or a year. In this group of patients surgery improves sight in ~80%. Eye 2011

 

 

 

 

 

 

 

epiretinal membrane drawing

Surgery...vitrectomy and epiretinal membrane peel

The surgery starts by passing small instruments through very small holes. Then the vitreous is removed. (The vitreous is the jelly in the middle of the eye..this part of the operation is called a 'vitrectomy').The membrane is then peeled off and removed.  animation.

The vitreous is replaced with clear fluid.

Surgery for ERM (vitrectomy) may be helpful if there is distortion of vision, or if the sight is worse than 6/12. Removing the ERM will usually help reduce the distortion, but may not improve the visual acuity. The more opaque the membrane, the more the benefit.

The best results are for patients whose sight is <6/18, and whose sight has deteriorated in the last 6 months.

 

removing an epiretinal membrane

Risks

As with any operation there are risks. The main risks are complications such as infection and retinal detachment, both of which can be very serious and cause severe loss of sight.

The risk of such a major problem is probably about 2% (1 in 50). Many patients will develop a cataract, and there are a number of minor problems (and rarely more serious problems) that can develop.

 

Causes of ERM

The condition occurs as people get older. We do not know the exact cause, but various conditions stimulate growth factor release, and these promote the growth of the membrane.

  • It may be related to a PVD. This occurs as the vitreous gel shrinks.
  • it may be related to other conditions with retinal damage, including
    • retinal tear (1/30)
    • retinal vein occlusion
    • laser treatment
  • Retina 2011Yazici
  • types of ERM/PVD

With a PVD, when the vitreous shrinks, it may release cells from the surface of the retina. These cells migrate and start to 'grow'  on the surface of the retina near the macula, and then start to shrink.
See ERM cause animation.

 

 diagram of vitreous and retinaPosterior vitreous detachment
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