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The human eye is a remarkable organ responsible for our sense of sight. The retina is a super complex delicate “wallpaper” lining the back of the eye, which acts like photographic film in a camera, picking up all the light and detail that enters the eye. It then sends the visual messages to the brain, and we “see”. The central part of the retina is called the macula, which is the part of the eye responsible for central vision, colour and fine detail such as reading and recognising people´s faces.

Certain eye conditions, such as epiretinal membrane (ERM), can affect the macula and compromise central vision, giving a central blur or vision distortion where images look bent out of shape. It is a fine scar which grows across the macula, which can be treated by eye surgery if it thickens and contracts.

Epiretinal membrane eye surgery is by the specialist vitreo-retinal surgeon and is called vitrectomy with microscopic epiretinal membrane peel. At Clinica London we have two vitreo-retinal surgeons, Ms Evgenia Anikina and Mr Julian Robins who are both highly skilled ophthalmic surgeons experience in vitrectomies. The vitreous is the jelly that filles the eye and sits in front of the retina. Epiretinal membrane peel is done under the microscope with ever so delicate microscopic eye instruments placed inside the eye to lift and remove the epiretinal membrane affecting your central vision.

In this blog, we will explore the process of ERM surgery, its benefits, and what patients can expect from this vision-restoring intervention.

What is Epiretinal Membrane?

Epiretinal membrane, commonly referred to as macular pucker, occurs when a thin layer of scar tissue forms on the surface of the retina and causes the retina to wrinkle, leading to distorted or blurred vision. The most common symptoms of ERM include decreased visual clarity, distorted central vision, and in some cases, straight lines appearing wavy. It is a common condition seen with ageing and is found in 10% of people. It often remains stable and does not require surgery. A proportion benefit from epiretinal membrane surgery where it can help restore vision.

Aim of Epiretinal Membrane Eye Surgery

Epiretinal membrane surgery offers significant benefits, with improved vision, enhanced contrast sensitivity, and a reduction in distortion. The surgery aims to restore visual acuity and quality of life for individuals affected by symptomatic ERM.

What is Epiretinal Membrane Surgery?

Epiretinal membrane surgery is delicate eye surgery performed by an ophthalmologist specialising in vitreous and retinal diseases. The surgery typically involves the following steps:

  1. Preoperative Assessment: Before the surgery, the ophthalmologist will conduct a comprehensive eye examination, including visual acuity tests, dilated fundus examination, and optical coherence tomography (OCT) to evaluate the extent and severity of the macular membrane.
  2. Anaesthesia: Prior to the surgery, local anaesthesia is administered to ensure the patient’s comfort. In some cases, general anaesthesia may be used, particularly if the patient has certain medical conditions or preferences.
  3. Small Incisions: The surgeon creates tiny incisions in the eye to gain access to the retina. These incisions are made using specialised microsurgical instruments.
  4. Vitrectomy: The surgeon removes the vitreous gel, a clear gel-like substance that fills the central part of the eye, through one of the incisions. This step allows the surgeon to access the affected retina.
  5. Membrane Removal: Using delicate microsurgical instruments, the surgeon carefully peels off the epiretinal membrane from the surface of the retina. Extreme precision is crucial during this step to avoid damage to the underlying retinal layers.
  6. Fluid Replacement: After the membrane removal, the vitreous gel is replaced with a clear fluid or a gas bubble, which helps the retina reattach and heal.
  7. Incision Closure: The small incisions are then closed using sutures or self-sealing techniques, which minimise the risk of infection and aid in the healing process.

Post-operative care Epiretinal membrane Surgery

Following the surgery, patients will require some postoperative care to facilitate healing and optimise visual outcomes. This will include the use of eye drops, specific positioning instructions, and temporary restrictions on activities such as heavy lifting or straining. The ophthalmologist will provide detailed instructions tailored to the patient’s specific needs.

Recovery time varies among individuals, but patients often experience some improvement in visual clarity within the first few weeks after surgery. Full recovery may take several months. During the recovery period, regular follow-up visits will be scheduled to monitor the progress and address any concerns.

As with any surgical procedure, there are potential risks involved, although they are relatively rare. These risks may include infection, bleeding, retinal detachment, increased intraocular pressure, and cataract formation. However, the overall success rate of ERM surgery is high, and the benefits typically outweigh the risks for most patients.

Epiretinal membrane surgery is a sophisticated procedure that holds the potential to restore vision in individuals affected by this condition. By removing the scar tissue from the surface of the retina, this surgery can help improve visual acuity and reduce distortion. While risks are present, the benefits of improved vision and enhanced quality of life make ERM surgery a viable option for many patients.

What to do if you think you have an epiretinal membrane

If you suspect you may have an epiretinal membrane, consult a vitreo-retinal ophthalmic surgeon who can guide you through the diagnosis and potential treatment options, including surgery, to restore your visual function and overall well-being.

Ten Interesting Facts About Epiretinal Surgery

Epiretinal membrane surgery, also known as macular pucker surgery or vitrectomy with membrane peel, is a surgical procedure performed to treat an epiretinal membrane (ERM) that forms on the surface of the retina. Here are some interesting facts about epiretinal membrane surgery:

  1. Epiretinal membrane: An epiretinal membrane is a thin layer of scar tissue that develops on the macula, which is the central part of the retina responsible for sharp vision. It can cause blurry vision, distortion, and sometimes even vision loss.
  2. Surgical procedure: Epiretinal membrane surgery involves the removal of the scar tissue from the surface of the retina. It is typically performed using a technique called vitrectomy, in which the gel-like substance inside the eye (vitreous) is removed, and the scar tissue is peeled off the retina.
  3. Microscopic precision: The surgery is highly delicate and requires microsurgical instruments and techniques. The surgeon makes tiny incisions in the eye and uses specialised instruments, including micro forceps, to carefully peel away the membrane from the retina.
  4. Local anaesthesia: Epiretinal membrane surgery is usually performed under local anaesthesia, meaning the patient is awake during the procedure. However, the eye is numbed with aesthetic drops or injections to ensure a pain-free experience.
  5. Outpatient procedure: In most cases, epiretinal membrane surgery is performed as an outpatient procedure, which means the patient can go home on the same day. However, the patient will need someone to drive them home after the surgery.
  6. Recovery time: The recovery time after epiretinal membrane surgery varies from person to person. Generally, it takes a few days to a few weeks for vision to improve, although it may continue to improve gradually over several months.
  7. Postoperative care: After the surgery, the patient may be required to use antibiotic or anti-inflammatory eye drops to prevent infection and reduce inflammation. The doctor may also recommend avoiding strenuous activities and heavy lifting during the recovery period.
  8. Success rate: Epiretinal membrane surgery has a high success rate, with most patients experiencing improved vision following the procedure. However, complete restoration of vision may not always be possible, especially in cases where the macula has been significantly affected.
  9. Risks and complications: Like any surgical procedure, epiretinal membrane surgery carries some risks and potential complications. These can include infection, bleeding, retinal detachment, elevated eye pressure, cataract formation, and persistent or recurrent membrane growth.
  10. Alternative treatments: In some cases, if the epiretinal membrane is mild and not significantly affecting vision, observation without surgery may be recommended. Additionally, certain medications, such as steroid eye drops or anti-VEGF injections, may be used to manage symptoms in select cases.

It’s important to consult with a surgical retinal specialist for a comprehensive evaluation and personalised information about epiretinal membrane surgery.

Book an appointment through our contact form or at 020 7935 7990.

Ms Evgenia Anikina 1

Ms Evgenia Anikina

Consultant Ophthalmic Surgeon
Cataract, Surgical Vitreoretinal (VR) and Medical Retina Specialist

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Mr Julian Robins 5

Mr Julian Robins

Consultant Ophthalmic Surgeon
Cataract, Vitreoretinal (VR) and Medical Retina Specialist

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