Epiretinal membrane is an eye condition, associated with age in many cases, which can be asymptomatic. However, purely physiologically, it is not uncommon for this condition to present with a series of symptoms significant enough to recommend surgery.
We will look at what causes this condition and when to operate on the epiretinal membrane, as well as what to expect from the surgery.
At Dr. Nebro's ophthalmology clinic we can carry out both the necessary tests to estimate the state of your macula and the surgery itself, avoiding delays in diagnosis and waiting lists.
What is the epiretinal membrane?
The epiretinal membrane is the name we give to the formation of scar tissue on the retina, specifically in the region of the macula, where the stimuli responsible for more precise vision are transmitted.
As a result of the formation of this membranous tissue, the macula may shrink and wrinkle, resulting in blurred vision.
It is estimated that about 8 % of people over 60 years of age have this condition, although macular epiretinal membrane surgery is only indicated in patients with visual impairment, not in asymptomatic patients.
Why does macular epiretinal membrane occur?
As mentioned above, epiretinal membrane formation is often associated with the patient's age. In most cases, it is a consequence of normal ageing of the vitreous gel, which usually leads to a subsequent vitreous detachment.
As a result of this vitreous detachment, which may go unnoticed, cells may be deposited on the macula of the retina and induce the formation of a fibrotic meshwork or membrane. When this mesh shrinks, visual disturbances appear.
In other cases, the formation of this membrane over the macula is related to pathologies such as diabetes, retinal venous obstruction, inflammatory processes affecting the retina or surgery involving the retina.
Symptoms it causes
There are two main symptoms, which are blurred vision and visual distortions. When we talk about visual distortions, we refer to disturbances such as seeing curved straight lines or objects that are relatively larger or smaller than their real size. Blurred vision is a symptom shared by so many diseases of the eye and optic nerve that some patients with this symptom alone delay seeing an ophthalmologist, believing that they simply need new lenses.
In some cases, we can diagnose epiretinal membrane with a simple fundus examination without the need to dilate the pupils, although the definitive test is optical coherence tomography (OCT). The OCT, which we can perform at our ophthalmology centre, not only confirms or denies the diagnosis, but also provides us with valuable information about the state of the inside of the eye in the affirmative case. With OCT, we know if there is an epiretinal membrane and when to operate.
How is the epiretinal membrane treated?
Since the tissue to be removed is located inside the eye, the only way to treat symptomatic cases is with surgery.
Surgical treatment
Surgery to remove the contracted or thickened tissue over the macula is performed by microsurgery, although, as mentioned above, a vitrectomy is necessary to reach the area. It is this part of the surgery that usually determines the postoperative course of the epiretinal membrane, depending on the type of replacement fluid chosen and whether or not a second operation is required.
Otherwise, surgery to correct the macular epiretinal membrane problem is relatively simple. Three millimetre incisions are made, always with the aid of a microscope, in the sclera, to introduce the devices that will carry out the surgery inside the eye.
The vitreous humour is then drained and the epiretinal membrane is peeled from inside the eyeball. Some surgeons also peel the macula very superficially, to reduce the risk of recurrences in patients with risk factors.
Full recovery of vision usually takes months, during which time it is normal to have blurred vision to a greater or lesser degree.
Epiretinal membrane is an eye condition associated with age and some diseases such as diabetes. It is a common condition in the elderly population, although if it does not produce symptoms, the only existing treatment is not applied: an ocular microsurgery that requires vitrectomy.
The definitive diagnostic test is optical coherence tomography, which not only confirms or denies, but also provides precise information about the state of the inside of the patient's eye. At our ophthalmology clinic we have the appropriate diagnostic equipment to carry out this test and we can also perform the surgery. The postoperative period is not usually complicated, although it does take a few months to recover clear vision.