An epiretinal membrane (also called macular pucker) is the formation of a thin membrane over part of the retina known as the macula. The macula is the most sensitive part of the eye and plays a central role in processing detailed vision.
Epiretinal membrane causes a mild decline in vision. Some signs include gradual loss of central vision or vision distortion (seeing straight lines as wavy).
The best way to detect the condition is through an eye examination. Your ophthalmologist will administer eye drops to enlarge the pupils temporarily so that he or she can check the back of your eyes (the retina) for holes. The eyes are also painlessly scanned with optical coherence tomography (a light used to check the different layers of the retina).
There is no proven prevention for this condition.
What causes epiretinal membranes?An epiretinal membrane occurs when the gel-like vitreous in the eye becomes more liquid and exerts an abnormal pull on the retina. This results in small pieces of retina breaking away from the inner wall of the eye.
When some vitreous remains on the macula, it stimulates the formation of scar tissue, or the growth of a thin membrane over the retina. Over time, these membrane cells contract and cause the retina to wrinkle, distorting vision. Deterioration of the vitreous can also cause other problems such as floaters and flashes, retinal tears, vitreomacular traction and retinal detachment.
Diagnosis is often made by clinical examination. Investigations like optical coherence tomography (OCT) and fluorescein angiography may be useful in confirming the diagnosis or excluding underlying causes.
An epiretinal membrane may be treated with a vitrectomy, a form of keyhole surgery that uses small probes to enter inside the eye to remove the vitreous and peel off the epiretinal membrane. A gas may then be injected into the eye to replace the vitreous and prevent it from pulling on the retina.
Following surgery, the patient may need to lie in a face-down position for one to two days to allow the gas bubble to press against the macula to smoothen it. The eye will refill naturally with fluid.
Eyes with long-standing epiretinal membrane may not be treated with surgery if the vision is unlikely to improve after surgery. Some epiretinal membranes may be present in the early stages which are less serious and may just require follow-up by an ophthalmologist.
The success of improving the vision varies from person to person and ranges from 80% to 90%. In the majority of eyes, the surgery improves the symptoms of blurred or distorted vision.
Eye drops may be prescribed for instillation before surgery. Fasting (no eating or drinking) for seven hours before surgery is required for safety.
Eye drops will be dispensed after surgery, and should be used as prescribed. Maintaining good eye hygiene and avoiding injury to the operated eye are important to reduce infection after surgery.
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