Epiretinal membrane

Epiretinal membrane

Table of Contents

What is an epiretinal membrane?

The epiretinal membrane is a fibrocellular membrane that forms on the inner surface of the retina. Generally, the epiretinal membrane affects the macula, which is the central portion of the retina that helps us to distinguish fine details like reading and recognizing faces.

While an epiretinal membrane can have minimal symptoms and can be checked every 6 months, in some cases it can lead to vision loss and metamorphopsia (visual distortion).

Before and after vitrectomy Copyright Retina Center

Causes

Epiretinal membranes form when glial cells on the surface layer of the retina migrate and start to grow in a membranous sheet on the retinal surface. The most common cause of an epiretinal membrane is a condition called posterior vitreous detachment, where the vitreous gel that fills the eye separates from the retina, causing imperceptible tears (micro-tears) and symptoms of floaters and flashes.

ERMs can be associated with a number of ocular conditions such as prior retinal tears or detachment, retinal vascular diseases such as diabetic retinopathy or venous occlusive disease; they can also be post-traumatic, occuring following ocular surgery, or be associated with intraocular (inside the eye) inflammation.

Epiretinal membrane after retinal detachment surgery

Risk factors

The risk of developing an epiretinal membrane increases with age, and persons with predisposing ocular conditions may develop ERM at an earlier age. Studies have shown that 2% of patients over age 50 and 20% over age 75 have evidence of ERMs, although most do not need treatment. Both sexes are equally affected. In about 10% to 20% of cases, both eyes have ERMs, but they can be of varying degrees of severity.

Diagnosis

Most epiretinal membranes can be diagnosed by an ophthalmologist during a routine clinical exam. Ocular Coherence Tomography (OCT) is an important imaging method used to assess the severity of the ERM. Sometimes, additional testing such as fluorescein angiography is used to determine if other underlying retinal problems have caused the ERM.

Normal retina on OCT
Epiretinal membrane (OCT)

Treatment

There are no eye drops, medications or injections to treat epiretinal membranes. A surgery known as a vitrectomy is the only option in eyes that require treatment. The vitrectomy procedure consists of making small incisions in the sclera (the white part of the eye), and removing the vitreous gel found inside the eye. This allows the surgeon to safely access the surface of the retina, delicately remove the epiretinal membrane with micro-forceps, and allow the macula to relax and become less wrinkled.

The risk of complications with a vitrectomy is small, with about 1 in 200 patients developing retinal detachment and 1 in 2000 developing an infection after surgery.

Epiretinal membrane regrowth after its initial removal is a rare complication and reoperation for ERM recurrence is uncommon. In this large series of patients, the incidence of ERM recurrence was 5% with 2% of the patients studied being reoperated.

Before and after vitrectomy with ERM peeling Copyright Retina Center

Factors affecting visual outcomes include

  1. Length of time the epiretinal membrane has been present
  2. The degree of traction
  3. Etiology (eyes with prior retinal detachment or retinal vascular disease have poorer prognoses).

Recovery time after surgery

Recovery is very quick and most patients can see an improvement within 2 weeks after surgery. The redness around the eye will take 2 weeks to disappear. You will see a small bubble moving around the eye and it will blur your vision for a few days after surgery. It will then dissolve by itself naturally.

I leave you some videos of our surgeries and don’t forget to visit our YouTube channel with hundreds of surgeries

Patient with mild and thin epiretinal membrane
Vitrectomy for epiretinal membrane

American Society of Retina Specialists

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