An epiretinal membrane or macular pucker is when scar tissue grows on the surface of the retina, directly over the macula. This scar tissue can contract and cause the retina to wrinkle leading to visual loss, as well as distorted or double vision.
Epiretinal membranes cause a variety of eye problems. They may follow retinal detachment surgery or retinal tear formation. They may be associated with retinal blood vessel problems. In most cases, the epiretinal membrane occurs in an otherwise healthy eye as a result of the posterior vitreous gel pulling loose from the macula.
The only treatment for visual loss caused by an epiretinal membrane is surgery to remove the membrane. It is best not to do surgery if the vision is only mildly reduced. However, if the visual loss or distortion is significant a vitrectomy may be performed to remove the membrane.
A vitrectomy entails removal of the vitreous gel, then the membrane is picked up with a fine instrument (intraocular forceps) and gently peeled off the surface of the retina. The surgery is usually performed under general anaesthesia.
A vitrectomy entails removal of the vitreous gel from the eye whereafter the epiretinal membrane is picked up with a fine instrument (intraocular forceps) and gently peeled off the surface of the retina. The surgery is usually performed under general anaesthesia.
Vision will slowly improve after surgery, with most of the improvement coming within the first three months, though it may continue to improve for many months. In some cases, the vision may not improve at all. This is usually related to a long duration of the membrane. On average, patients regain approximately half of the vision that was lost because of the epiretinal membrane. In almost all patients, distortion decreases markedly. However, in some patients, the aim of surgery is to stabilise the condition and reduce the chance of further deterioration.
The complications of the surgery include retinal tears and detachment, infection and regrowth of the membrane. These complications may result in mild to total loss of vision, though vision losing complications are rare.
Cataract occurs in almost all cases within one to two years following surgery. If cataract changes are already present, then the epiretinal membrane surgery will be combined with a cataract extraction and artificial lens replacement.