Treatment Options
The only established treatment for epiretinal membrane is pars plana vitrectomy.
Step 1 – Learn the basics about epiretinal membranes
Step 2 – Learn about the surgery and what to expect
Step 3 – Learn about the other options
Step 4 – Learn about the potential risks of the procedure
Step 5 – Learn to maximize your results
The eye can be thought of as similar to a camera, with two main parts, a lens and a film. In addition, there is a gel called the vitreous that is located in front of the retina and is very firmly adherent to it. The film layer is called the retina and lines the back wall of the eye. The area of the retina responsible for our central vision is called the macula.
The vitreous separates from the back of the eye towards the front of the eye as a normal part of aging (posterior vitreous detachment). During this process, some vitreous cells may remain overlying the macula, and proliferate over time. The cells may form a sheet of scar tissue which pulls on the surface of the retina. The pulling force on the macula may cause a decrease in vision or distortion.
An epiretinal membrane is removed with an outpatient surgical procedure called a pars plana vitrectomy. It may be performed under under twilight (awake, relaxed, and painless) or general anesthesia.
The retina specialist places 3 small ports that are approximately 0.5 millimeters in size through the white of the eye and into the vitreous cavity. Fluid is infused into the vitreous cavity while the surgeon uses a vitrectomy probe to carefully removes the vitreous. The surgeon then carefully peels the epiretinal membrane off of the surface of the retina. Some surgeons may also elect to peel the internal limiting membrane, which is a very thin membrane which sits underneath the epiretinal membrane. An eye patch and eye shield are then placed on the eye.
The only established treatment for epiretinal membrane is pars plana vitrectomy.
The retina specialists who recommends the treatment will discuss the risks, benefits, and alternatives to the procedure. It is up to the judgement of the physician to weigh the benefit of the procedure to the potential risks. It is only once the decision is made that the benefits outweigh the potential risks is the procedure offered to the patient. This is generally considered to be a very safe procedure.
Pars plana vitrectomy typically results in a slow improvement in vision and significant improvement in distortion. The visual improvement typically occurs over 3-6 months, but may continue to improve up to 1 year.
The most significant risk of pars plana vitrectomy is worsening of a pre-existing cataract.
Additional risks of the surgery include retinal detachment and infection.
Symptoms of retinal detachment include the sudden onset of many new floaters, new onset flashing lights, or noting a progressive decrease in the peripheral vision (like a curtain coming down at a play). This is urgent and the treating physician should be made aware the same day.
There is a small risk of infection following the procedure. If this is going to occur, it typically occurs 3-5 days following the procedure. Symptoms include redness around the eye that gets worse not better, extreme light sensitivity, and worsening pain. This is a medical emergency and requires immediate treatment by a retina specialist.
Patients who still have their nature lens will experience progression of their cataract following vitrectomy surgery. Approximately 90% of patients who are 50 years or older will require cataract surgery within 2 years.
All surgeries are associated with a number of other uncommon, but possible problems. Potential complications of pars plana vitrectomy include high eye pressure, bleeding within the eye, development of new retinal tears, and the need for further procedures.
It is important to use eye drops as prescribed by your retina specialist. Patients should ask if they need to continue to use prescription eye drops they were using prior to surgery (such as for glaucoma).
The vision is typically very blurry the day following surgery. It improves significantly during the first week, and then slowly thereafter.
Peripheral vision – The peripheral vision should gradually become clearer. If the peripheral vision becomes dark and starts to become larger, this is a sign of a retinal detachment.
Infection – The eye should continue feeling better following surgery. Infection is characterized by a combination of severe eye pain, profound light sensitivity, and a decrease in vision. This must be treated emergently.
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