Please scroll to the bottom of the page to watch video clip of Mr. David performing an Epiretinal membrane peel
Epiretinal membrane (macular pucker/cellophane maculopathy) is the name given to a form of scar tissue which grows across the macular area of the retina. The macula provides the sharp, central vision we need for reading, driving, and seeing fine detail.
What causes an epiretinal membrane ?
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.
What are the symptoms of an epiretinal membrane ?
Vision loss from a epiretinal membrane can vary from no loss to severe loss, although severe vision loss is uncommon. People with an epiretinal membrane 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 grey area in the centre of your vision, or perhaps even a blind spot.
How is an epiretinal membrane treated?
The treatment of an epiretinal membrane depends on symptoms it causes and its effects on the retina. Mr. David will advise you on the best treatment for you based on your symptoms and a careful clinical assessment.
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 an epiretinal membrane.
Sometimes, vision deteriorates to the point where it affects daily routine activities or vision starts to get blurry due to swelling(oedema) of the macula. However, when this happens, Mr. David may recommend surgery.
During your operation three needle-sized holes (0.64mm) are made in the white of the eye allowing removal of the vitreous jelly. This will allow Mr David to treat the epiretinal membrane with delicate intraocular instruments that are used to remove the scar tissue that causes the retina to wrinkle.
The vitreous jelly will be replaced by balanced salt solution.
Small stitches (that dissolve spontaneously) are usually placed in the eye and at the end of the operation we will put a pad or bandage over your eye to protect it and reduce swelling.
Mr. David will advise you on the posture you need to maintain and the duration of the same after you operation.
By following our instructions you will give your macula the best chance to be successfully treated. Your co-operation matters a great deal.
Who will perform my surgery?
Mr. David performs all private procedures himself. There may be an assitant or trainee observing but will not perform any part of your operation.
What type of anaesthesia is used?
Mr David now performs the majority of his Epiretinal membrane surgery as a day case under local anaesthetic. General anaesthetic is still available for anxious patients. If having a general anaesthetic you should not eat or drink for 6 hours before the procedure. If having a local then light food and drink is allowed up to 1 hour before the procedure.
Before the operation both Mr David and the anaesthetist will speak to you and examine you on the ward. You will then be given eye drops to enlarge your pupils. When you arrive in the anaesthetic room a needle will be placed in your hand or arm.
After the Operation
Most patients are able to leave hospital within a few hours of the procedure. If you have discomfort we suggest that you take a pain reliever, such as Paracetamol every 4-6 hours. It is normal to feel itching, sticky eyelids and mild discomfort for a while after ERM surgery. It is common for your eye to water. Occasionally the area surrounding the eye can become bruised. Any discomfort should ease after 2-3 days. In most cases your eye will take about 6 weeks to heal. You will normally see Mr David in the clinic 2 weeks after your operation. Try to rest while your eye is healing.
We will give you eye drops to reduce any inflammation and to prevent infection. We will explain how and when you should use them. Please do not rub your eye.
Certain symptoms could mean that you need prompt treatment. Please contact the hospital immediately if you have any of the following symptoms:
· A lot of pain.
· Loss of vision
· Increasing redness of the eye.
· A shadow developing in the vision
How successful is this surgery?
Surgery for epiretinal membranes is very delicate and is usually successful in removing it.
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. Mr. David will discuss with you what the likely visual improvement following your surgery.
Risks of surgery
There is a risk of complications, either during or after the operation. Minor complications are common and in most cases we can treat them effectively. Very rarely some complications can result in blindness.
Possible complications during the operation:
· Bleeding inside the eye
· More holes in the retina
· Dislocation of any intraocular lens
Possible complications after the operation:
· Bruising / swelling of the eye or eyelids
· High pressure inside the eye
· Inflammation inside the eye
· Double Vision
· Allergy to the medication used
· Infection in the eye (endophthalmitis). This is very rare, but can lead to serious loss of sight
· Inflammation around any implants used
· Retinal detachment