Abstract
An epiretinal membrane is a semitranslucent fibrous “membrane” on the surface of the retina. It is also called macular pucker or cellophane maculopathy because of its tendency to look like clear plastic wrap that is wrinkled on top of the retina. This membrane can develop on the surface of the macular area and cause a disturbance in vision.
Full Article
The macula is the central part of the retina and is responsible for our sharp, detailed, central vision such as used during driving or reading. An epiretinal membrane is a semitranslucent fibrous “membrane” on the surface of the retina. It is also called macular pucker or cellophane maculopathy because of its tendency to look like clear plastic wrap that is wrinkled on top of the retina. This membrane can develop on the surface of the macular area and cause a disturbance in vision.
An epiretinal membrane develops as a result of cellular changes that occur at the back of the eye between the clear vitreous gel, that is normally present, and the macula. Normally, cells from the retina and other tissues within the eye become liberated into the vitreous gel and settle onto the surface of the macula. These cells may begin to proliferate into a “membrane”. Sometimes, this membrane remains very mild and does not have a significant effect on the macula or the person’s vision. However, in other cases the membrane may slowly become more prominent, eventually creating a disturbance in the retina which leads to visual blurring and/or distortion for the patient.
Most cases of epiretinal membrane develop in an eye with no history of previous problems. This is called an idiopathic epiretinal membrane. In other cases, an epiretinal membrane can develop secondarily after problems that occur within the eye. Epiretinal membrane can occur after a retinal break or retinal detachment, trauma, inflammatory disease, vein occlusion, or intraocular surgery.
Most epiretinal membranes occur in people over the age of 50 and occur equally in males and females. They only require treatment when symptomatic to the patient. Symptoms patients may experience include distortion of their vision. This is often manifested when reading as being unable to see all of the letters on the line clearly. Patients may also experience seeing objects as smaller than normal. Other symptoms include decreased vision and having double vision.
The most common treatment for epiretinal membrane is vitrectomy surgery with peeling of the epiretinal membrane off the other layers of the retina. This surgery is done on an outpatient basis under local anesthesia. The surgery consists of making very small incisions on the white part of the eye (the sclera) so that the surgeon can gain access to the back of the eye to work. The surgeon then looks into the eye through a microscope and uses specialized instruments to complete the necessary work. The vitreous gel is first removed and replaced with a specially designed saline solution. Next, the surgeon can peel the membrane from the surface of the macula. Sometimes, a air bubble is placed in the eye to help flatten the retina. The air bubble gradually goes away on its own and is replaced by the eyes normal intraocular fluid.
Vision improvement after surgery varies from patient to patient. Approximately one half to three quarters of patients have some improvement; however, complete return to normal is rare.
Tenley Bower, MD, ARCT