Professor Pearce Liverpool Ophthalmologist and Retinal Expert
An epiretinal membrane is scar tissue that has formed on the eye’s macula, located in the centre of the light-sensitive tissue called the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail. An epiretinal membrane can cause blurred and distorted central vision.
Epiretinal membrane is also known as macular pucker , preretinal membrane, cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, premacular fibrosis, and internal limiting membrane disease.
No. A macular pucker and age-related macular degeneration are two separate and distinct conditions, although the symptoms for each are similar.
Although both have similar symptoms - distorted and blurred vision - an epiretinal membrane and a macular hole are different conditions. They both result from tugging on the retina from a shrinking vitreous. When the vitreous separates from the retina, usually as part of the ageing process, it can cause microscopic damage to the retina. As the retina heals itself, the resulting scar tissue can cause a macular pucker. Rarely, a macular pucker will develop into a macular hole. An eye care professional can readily tell the difference between macular pucker and macular hole.
Vision loss from an epiretinal membrane can vary from no loss to severe loss, although severe vision loss is uncommon. People with a macular pucker may notice that their vision is blurry or mildly distorted, and straight lines can appear wavy. They may have difficulty in seeing fine detail and reading small print. There may be a gray area in the center of your vision, or perhaps even a blind spot.
For most people, vision remains stable and does not get progressively worse. Although an epiretinal membrane affects one eye worse than the other it is common to see remnants of epiretinal memebranes in both eyes.
Most of the eye’s interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibres that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is called a vitreous detachment, and is normal. In most cases, there are no adverse effects, except for a small increase in floaters, which are little “cobwebs” or specks that seem to float about in your field of vision.
However, sometimes when the vitreous pulls away from the retina, there is microscopic damage to the retina’s surface (Note: This is not a macular hole). When this happens, the retina begins a healing process to the damaged area and forms scar tissue, or an epiretinal membrane, on the surface of the retina. This scar tissue is firmly attached to the retina surface. When the scar tissue contracts, it causes the retina to wrinkle, or pucker, usually without any effect on central vision. However, if the scar tissue has formed over the macula, our sharp, central vision becomes blurred and distorted.
A macular pucker usually requires no treatment. In many cases, the symptoms of vision distortion and blurriness are mild, and no treatment is necessary. People usually adjust to the mild visual distortion, since it does not affect activities of daily life, such as reading and driving. Neither eye drops, medications, nor nutritional supplements will improve vision distorted from macular pucker. Sometimes the scar tissue – which causes a macular pucker – separates from the retina, and the macular pucker clears up.
Rarely, vision deteriorates to the point where it affects daily routine activities. However, when this happens, surgery may be recommended. This procedure is called a vitrectomy, in which the vitreous gel is removed to prevent it from pulling on the retina and replaced with a salt solution (Because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous). Also, the scar tissue which causes the wrinkling is removed. A vitrectomy is usually performed under local anesthesia.
After the operation, you will need to wear an eye patch for 24hours. You will also need to use medicated eye drops to protect against infection.
Surgery to repair an epiretinal membrane is very delicate, and while vision improves in most cases, it does not usually return to normal. On average, about half of the vision lost from a macular pucker is restored; some people have significantly more vision restored, some less. In most cases, vision distortion is significantly reduced. Recovery of vision can take up to six months. Patients should discuss with Professor Pearce about whether treatment is appropriate.
The most common complication of a vitrectomy is an increase in the rate of cataract development. Cataract surgery may be needed within a few months after the vitrectomy. Other, less common complications are retinal detachment either during or after surgery, and infection after surgery. Also, the epiretinal membrane may grow back, but this is uncommon.
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