Good Hope Eye Clinic

Epiretinal membrane 

David Kinshuck

 

 

 

Explanation

epiretinal membrane drawing

 

Epiretinal membrane ('ERM') formation is also called cellophane maculopathy or macular pucker. It is not a type of macular degeneration.

The central part of the retina is affected. A very thin film or membrane develops on the surface of the retina. This membrane, very like 'cling-film', starts to shrink, and this causes wrinkling of the retina.

The wrinkling may be mild, in which case surgery is not recommended. In such a patient the sight would be good or reasonable, and stable and not getting worse.
Leaflet Moorfields  Epiretinal membrane.

 

Vision

The vision can be affected in various ways.

  • Central vision can be reduced, causing generally blurred vision.
  • Alternatively, images may appear bent or wavy. Distorted vision: the distortion is related to the retinal pulling Eye 2013.

If the sight does get worse and the wrinkling increase, then surgery may be recommended. Only ~30% people notice an increase in the wrinkling, and their sight will deteriorate over months or a year. In this group of patients surgery improves sight in ~80%. Eye 2011.  Photoreceptor damage JAMA 2013. Surgery is not recommended in 'mild' or 'early' membrane formation.

 

Causes of ERM

Posterior vitreous detachment

See ERM cause animation.

When the vitreous shrinks (posterior vitreous detachment (a PVD),  it may release cells from the surface of the retina. These cells migrate and start to 'grow'  on the surface of the retina near the macula, and then the retina start to shrink. See ERM cause animation.

The condition occurs as people get older. We do not know the exact cause, but various conditions stimulate growth factor release, and these promote the growth of the membrane.

It may be related to other conditions with retinal damage, including Retina 2011 Yazici, retinal tear (1/30), retinal vein occlusion, laser treatment

 

Patient 1

This patient has had an ERM for 4 years. The vision was 6/9 and has deteriorated a tiny amount to 6/12, with a lttle distortion. The ERM is seen as wrinkling on the OCT (blue arrow below). The entire central retina is thicker than the opposite eye (OCT and photo just further below).

OCT or epiretinal mebrane

ERM..top OCTand photo, blue arrow. The membrane is just visible on the photo (blue arrow). Other eye bottom OCT, normal (minimal ERM). Patient age 68y, female, enlarge

 

Patient 2

an epriretinal membrane, a common cause of visual problems an epriretinal membrane, a common cause of visual problems , enlarge

 

Surgery...vitrectomy and epiretinal membrane peel

removing an epiretinal membrane

The surgery starts by passing small instruments through very small holes. Then the vitreous is removed. (The vitreous is the jelly in the middle of the eye..this part of the operation is called a 'vitrectomy').The membrane is then peeled off and removed.  animation. The vitreous is replaced with clear fluid.

Such vitrectomy surgery for ERM may be helpful if there is distortion of vision, or if the sight is worse than 6/12. Removing the ERM will usually help reduce the distortion, but may not improve the visual acuity. The more opaque the membrane, the more the benefit. The best results are for patients whose sight is <6/18, and whose sight has deteriorated in the last 6 months.

 

Risks

As with any operation there are risks. The main risks are complications such as infection and retinal detachment, both of which can be very serious and cause severe loss of sight.
The risk of such a major problem is probably about 2% (1 in 50). Many patients will develop a cataract, and there are a number of minor problems (and rarely more serious problems) that can develop.