Epiretinal - Epiretinal membrane

The Epiretinal membrane, or Epiretinal membrane, is a membrane that begins to form on the macula. It develops slowly and affects central vision causing blurring and distortion in the image.

Over time it grows and hardens and creates an attraction which leads to swelling (fluid collection).

This membrane begins to appear in the 50s (3-5% of the population and progressively increases per decade (to 20% in the 70s).

The idiopathic form, which is the most common, is not caused by any condition but only by age. However, there are also cases due to certain eye diseases such as: diabetic retinopathy, posterior vitreous detachment, retinal detachment, trauma, inflammation, etc.

Symptoms

Blurred vision
Diplopia, which is perceived with one eye covered
Distorted vision (straight lines may appear slanted or wavy)

Diagnosis

The diagnosis of the condition is made during the eye examination with the examination of the funduscopy. During the fundoscopy the membrane is in the form of a shiny gelatin.

The reduction in vision due to the epiretinal membrane is measured by testing visual acuity and the amount of distortion (distorted-scattered lines) is measured by the Amsler chart. .

The confirmation of the problem, as well as the imaging of its size, is done with optical coherence tomography (OCT), which is a new imaging and diagnostic method of the eye, which achieves high-resolution cross-sectional images of the retina without coming into contact with the eye.

Treatment

Treatment of the condition is only surgical.

The decision for surgery is made when vision is low or when it is found to be progressively deteriorating.

Surgical removal of the membrane is a very specialised and delicate operation. It is included in the difficult operations of the eye, not so much for the severity as for the delicacy of the surgical manipulations, but also for the extreme sensitivity of the area, which, it should be noted, is irritated simply by light.

We understand how delicate manipulations are required in this area to avoid permanent damage from surgical manipulations.

The surgical treatment is the method of vitrectomy. In recent years, highly intelligent and sensitive machines and instruments as thin as the thickness of an insulin needle have been used.

Postoperative recovery of vision takes up to 6 months. This is because the reduction of vision due to the epiretinal membrane is gradual and long-lasting and therefore the return of vision takes a long time.

The postoperative goals are two:

The anatomical result (removal of the membrane and elimination of the traction-swelling) and the functional recovery (resumption of the function of cells that after a long time are back in place).
Increased vision.

Complications

An eye infection is a very serious complication that requires urgent treatment.
There is a small risk of retinal detachment in the first few months after surgery.
In addition, patients who have not undergone cataract surgery may experience an acceleration of the normal progression of cataracts.

Success rates

The success rates are:

70% increase in vision usually around 2-3/10, but can rarely be more.
25% stabilization of vision at the level it was on the day of surgery.
5% reduction in vision despite the anatomical success of the surgery.

Therefore the decision to treat the condition surgically is a one-way street, as it offers a total of 95% positive results and only 5% negative results. While in the opposite case, not operating on the eye, vision will end up 100% at very low levels.