The retina is the thin layer of nerve tissue lining the back of the eye. The retina functions much like the film in a camera and transmits light signals to the brain. The central and most sensitive part of the retina is called the “macula”.
What is an epi-retinal membrane or Macular Pucker?
An epi-retinal membrane or macular pucker is a fine layer of scar tissue that may grow on the surface of the retina.
The membrane often builds up slowly over time and may contract causes wrinkling of the retinal surface which may affect your vision.
The epiretinal membrane can grow in different shapes which can affect the quality of the vision and quality of life.
What are the symptoms?
The majority of cases are mild and have a limited impact on vision. However, in some people, the membrane may continue to grow slowly causing further wrinkling of the retina resulting in:
- Distortion of the image (straight lines appear wavy).
- Blurred vision particularly reading.
- Difference in the size of the image between both eyes.
Once diagnosed with epiretinal membrane it is important to regularly check your central vision with a certain grid called “Amsler grid”. This is a simple square containing a grid pattern and a dot in the middle. With epiretinal membrane, you may notice the lines are wavy or distorted.
What causes it?
The exact cause of epiretinal membrane is unknown. Normally, the eye is filled with a gel-like substance called the “vitreous”. As we age, the vitreous shrinks and separates from the surface of the retina in a process called posterior vitreous detachment or separation. In some people, for an unknown cause, this may irritate the retinal surface causing this scar tissue (membrane) to build up on the surface of the retina. These are often called primary epi-retinal membranes. This condition often affects senior people over 60 years.
However, sometimes this membrane can form following previous retinal surgery, retinal laser treatment, eye injury or inflammation, often called secondary epi-retinal membranes.
What is the treatment for epiretinal membrane?
In many patients, the membrane is minimal and has only a limited impact on vision, therefore, no treatment is needed. However, in some people, the membrane can be large causing significant visual disturbance making it difficult to carry out daily activities as driving or reading. In such cases, the doctor may consider a treatment which is surgery to remove the membrane. Eye drops or stronger glasses will not help
The surgery is called “vitrectomy” which involves removing the gel inside the eye using very small instruments. Then the membrane is peeled off the retina with the aid of a fine micro-forceps.
Vitrectomy surgery is performed with the aid of local anaesthetic (small injection of anaesthetic solution around the eye) as a day surgery. Your eye will be numbed and you will not feel any pain, although you may feel some pressure sensation during the surgery. The surgery often takes about 45 minutes. The surgery is often combined with cataract surgery if you have a cataract.
Mr Ellabban will discuss with you the details of the surgery and advise you about the procedure.
Should I have the surgery for my epiretinal membrane?
Mr Ellabban will discuss with you in details about the surgery. The main reason to proceed with the surgery is to attempt to improve vision. If your symptoms are minimal and you are not aware of any visual problems, you might not need the surgery. However, if the distortion affects your ability to drive, read or to perform important tasks, you should consider having the surgery.
Will my vision recover completely after the surgery?
When the membrane is removed by surgery, you will usually notice an improvement in vision particularly in the quality of vision. This usually takes few weeks to months to reach the final improvement as the retina heals after the surgery. You will be followed with the aid of retinal scans to monitor the healing process and restoration of the retinal layers. Also, the central distortion and blurring will gradually improve after surgery, however, it will not be completely restored as normal.
What are the risks of the surgery?
Vitrectomy surgery has similar risks as other types of eye surgery. There is a small risk of complications such as:
- Prolonged Inflammation
- Retinal detachment
- Increased eye pressure
- Distortion or alteration of vision
What will happen afterwards?
Mr Ellabban will arrange a review after the surgery, to monitor the healing process of the retina. You will be monitored with the aid of retinal scans to assess the healing process and restoration of the retinal layers.
What I need to do after the surgery?
You are advised to follow the instructions you were given after the surgery by Mr Ellabban and the nursing team. In general, there are important points to follow, after retinal surgery:
- Put the drops as you were instructed.
- Avoid rubbing your eyes for 2 weeks.
- Avoid heavy lifting and straining for 2 weeks.
- Avoid getting soap or shampoo or any chemicals into your eye for 4 weeks.
- Avoid swimming for 12 weeks.
- You must not drive until you reach the minimum legal standard of vision.
- It is normal for the eye to appear red or uncomfortable for a few days after the surgery which will gradually get better over time.
What if I don’t have surgery?
As mentioned above, most cases of epi-retinal membrane are mild and no treatment is required. The surgery is only indicated for selected cases where the membrane is large or has a significant impact on vision while performing daily activities like reading or driving.
If no surgery is performed, the vision will remain the same but in about 10-20 %. The epi-retinal membrane may grow overtime causing more distortion and blurring.