Diseases
Overview
Age-Related Macular Degeneration
Diabetic Retinopathy
Retinal Vein and Artery Occlusions
Flashes of Light and Floaters
Retinal Tears and Retinal Detachments
Macular Pucker (Epiretinal Membrane)
Macular Hole
Vitreomacular Traction
Uveitis (Inflammation in the Eye)

Macular Pucker (Epiretinal Membrane)

What is an Epiretinal Membrane?
Epiretinal membrane (ERM) can also be known as “macular pucker” or “cellophane retinopathy” and is scar tissue on the surface of the retina that causes wrinkling and distortion of the normal anatomy of the macula. Since the macula is responsible for central vision, a small change can cause significant visual problems. An ERM can be due to the normal aging process of the eye, retinal tears, prior surgery, eye trauma, or inflammation. When the retina is damaged it, like all tissues, will try to heal itself and release cells that form scar tissue. Sometimes the scar forming cells land on the surface of the retina and begin to proliferate and, while this tissue does not cause any direct damage to the retina, it can contract as it matures and distort the structure of the retina. 

Epiretinal membranes can affect the macula, causing decreased central vision 
 
What are the symptoms of an Epiretinal Membrane?
As the retinal anatomy changes the vision may begin to worsen. While not specific to changes from an ERM, the most common symptom is the vision becoming blurred or “smudged” and can occur in the central vision or near the center. More specifically to an ERM is the vision remaining clear but becoming distorted. Straight lines such as door frames, window blinds, or highway stripes may develop waviness or bumps. It is very important for a detailed examination to ensure an ERM is the cause of vision changes and not a more serious condition.
 
How is an Epiretinal Membrane diagnosed?
To diagnosis an ERM, a thorough examination of the retina through a dilated pupil is necessary. The epiretinal membrane can be seen on the surface of the retina and the amount of distortion can be assessed. Often, a scan of the retina with an Optical Coherence Tomography (OCT) is performed that allows the retinal layers to be analyzed and the ERM measured. It is also very important to evaluate the eye for a potential cause of the membrane, as there are many conditions that can cause permanent vision loss if not treated.

OCT scan of epiretinal membrane distorting the normal retinal structure

What do you do about an Epiretinal Membrane?
Initially, the membranes can be observed until the level of distortion and visual compromise becomes significant. The treatment for an epiretinal membrane is surgical removal with a Pars Plana Vitrectomy and is performed in the operating room under sterile conditions. Small incisions are made in the eye and, using a microscope for viewing, small instruments are used to remove the vitreous gel that fills the inner eye. After the gel is removed, high magnification is used to visualize the scar tissue and specialized forceps carefully peel the scar tissue from the surface of the retina. Depending on the nature of the membrane, the innermost layer of the retina, the internal limiting membrane, may also be removed at the same time. Following surgery, the retinal distortion resolves and the vision improves. The level of visual recovery is different for every patient and can take several months before maximum improvement is achieved.
Dr Kruti Dajee Dr Jawad Qureshi Dr Johnathan Warminski