Epiretinal Membrane

The vitreous begins to shrink and pull away from the retina as we age. The vitreous pulls away and stick to the retina. Scar tissue forms, causing the retina and macula to wrinkle.

An epiretinal membrane is scar tissue that has formed on the eye's macula, located in the centre of the light-sensitive tissue called the retina. The macula provides sharp, central vision to see fine detail. A epiretinal membrane can cause blurred and distorted central vision.

Epiretinal membrane is also known as macular pucker, preretinal membrane, cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, premacular fibrosis, and internal limiting membrane disease.

The eye's interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibres that are attached to the surface of the retina.

As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is called a vitreous detachment, and is normal. In most cases, there are no adverse effects. However, sometimes when the vitreous pulls away from the retina, there is microscopic damage to the retina's surface.

When this happens, the retina begins a healing process to the damaged area and forms scar tissue, or an epiretinal membrane, on the surface of the retina. This scar tissue is firmly attached to the retina surface. When the scar tissue contracts, it causes the retina to wrinkle, usually without any effect on central vision. However, if the scar tissue has formed over the macula, our sharp, central vision becomes blurred and distorted.

Vision loss can vary from no loss to severe loss, although severe vision loss is uncommon. Patients may notice that their vision is blurry or mildly distorted, and straight lines can appear wavy. They may have difficulty in seeing fine detail and reading small print. There may be a grey area in the centre of your vision, or perhaps even a blind spot.

An epiretinal membrane usually requires no treatment. In many cases, the symptoms of blur vision and vision distortion are mild, and no treatment is necessary. Patients usually adjust to the mild visual distortion, since it does not affect activities of daily life, such as reading and driving. Neither eye drops, medications, nor nutritional supplements will improve vision distorted from macular pucker. Sometimes the scar tissue separates from the retina, and the epiretinal membrane clears up.

Rarely, vision deteriorates to the point where it affects daily routine activities. However, when this happens, surgery may be recommended. The procedure (vitrectomy), in which the vitreous gel is removed to prevent it from pulling on the retina and replaced with a salt solution. Also, the scar tissue which causes the wrinkling is removed. A vitrectomy is usually performed under local anaesthesia. After the operation, patient will need to wear an eye patch for a few weeks to protect the eye. Medicated eye drops are given to protect against infection.

Surgery to repair an epiretinal membrane is very delicate, and while vision improves in most cases, it does not usually return to normal. On average, about half of the vision lost from an epiretinal membrane is restored; some people have significantly more vision restored, some less. In most cases, vision distortion is significantly reduced. Recovery of vision can take up to three months. The most common complication of a vitrectomy is an increase in the rate of cataract development. Other complications are retinal detachment either during or after surgery, and infection after surgery. Also, the epiretinal membrane may grow back, but this is rare.