Epiretinal Membrane (ERM)
Epiretinal membrane (ERM) is a condition where a thin layer of scar tissue grows over the surface of the retina, specifically in the macula (center of the retina). ERM also goes by other names, including macular pucker, cellophane maculopathy, or a retina “wrinkle”. As this membrane grows and starts to contract, it leads to swelling in the retina and distortion of the central vision.
Causes & Symptoms
This demonstrates an epiretinal membrane in the macula. Notice the appearance of wrinkled cellophane.
The most common symptom patients with an ERM experience is distortion of the central vision. Patients may also notice blurring of central vision and sometimes even double vision. Patients may find themselves closing the affected eye to see better while reading and driving.
When the vitreous gel separates from the retinal surface (i.e., posterior vitreous detachment (PVD)), it sometimes leaves a layer of this gel behind on the retinal surface. Over time, this layer of gel thickens, and the cells remaining on the retina grow into a thin sheet of scar tissue. Typically, this is a spontaneous event, and it cannot be prevented or predicted. The risk factors for an ERM to form include a retinal tear or detachment, diabetic retinopathy, retinal vein occlusion, and inflammation in the eye (uveitis).
Treatment
In many cases, the ERM is mild and does not have a major impact on the vision. In these patients, no treatment is needed, and patients can be safely monitored for any signs of progression. ERMs do not usually progress quickly, and patients can often be safely monitored at 4-6 month intervals. When the ERM begins to affect a patient’s ability to read, drive, or perform normal activities, surgery is often indicated.
Surgery
Epiretinal membranes are often stained blue to make them more visible during surgical removal (peeling). This illustrates a membrane being peeled from the macula.
Post Surgery
Following surgery, patients will need to use antibiotic and steroid eye drops for about 3-4 weeks, and a shield/patch will be needed over the eye just while sleeping. There is no special positioning required after surgery (i.e., face down). In the first week after surgery, patients may perform light activities and can read, watch TV, and use the computer without restriction. In most cases, normal activities can be resumed 1 week following surgery.
In the majority of cases, the vision improves slowly after surgery for an ERM, with most of the improvement coming in the first 3 months. However, it is possible for vision to continue to improve for up to 2 years following surgery. Unfortunately, the vision will likely never be 100% normal, and some degree of distortion may be permanent. However, most people experience a significant improvement in the visual distortion/blurring compared to before the surgery.
Surgical Risks
Overall, the risks of this surgery are low and include bleeding, infection, retinal detachment, and loss of vision. While these risks are small, they can rarely lead to blindness in the operated eye. It is important to discuss and understand these risks with your surgeon. Cataract progression is normal and expected after this type of surgery, except if a patient’s cataract has already been removed, since cataracts do not regrow.
Conclusion
ERM formation is very common and, in most cases, is mild enough that they do not require treatment. If the ERM begins to severely affect the vision, surgery can be performed that is relatively low risk and with a very high success rate in improving vision.
Need more information?
American Society of Retina Specialists - ERM
American Academy of Ophthalmology - ERM
Schedule a Consultation for Epiretinal Membrane
At Mid Atlantic Retina Specialists, our team of experienced retina specialists can diagnose and treat a wide variety of retinal conditions, including epiretinal membranes. Request an appointment today at one of our retina centers in Hagerstown, MD, Frederick, MD, Chambersburg, PA, or Bedford, PA.
