Epiretinal Membrane and Vitreomacular Traction
A membrane-like gel with condensations called “vitreous” lines the back or part of the eye and makes up most of its volume. It is composed of largely of water and collagen with some condensed areas. It also has several attachment points to the nerve tissue lining in the back of the eye called the retina.
In most people 65 and older, the vitreous membrane separates from the surface of the retina. This is known as a “posterior vitreous detachment”. Occasionally, the vitreous separates incompletely or firm attachments develop that can cause visual symptoms.
An epiretinal membrane, also known as cellophane maculopathy or a macular pucker, is a membrane that may form on the surface of the retina and can be caused by a variety of eye disorders. A macular epiretinal membrane, or epimacular membrane, is caused by a remnant of vitreous that remains attached to the central part of the retina (the macula), which is responsible for sharp vision.
These membranes can sometimes contract and may be thought of as a form of scar tissue. This contraction can cause decreased or distorted vision and splitting in the layers of the retina. Epiretinal membranes can also be caused by other underlying eye conditions, such as diabetes, blood vessel occlusions, a previous retinal tear or detachment, and inflammation.
Occasionally, the vitreous only partially separates from the retina or fails to separate from the retina normally, which leads to a mechanical tension called a vitreomacular traction. Vitreomacular traction can also cause decreased and distorted central vision.
Epiretinal Membrane Treatment
Epiretinal membranes may or may not cause symptoms. With recent advances in eye imaging, many previously unrecognized epiretinal membranes are discovered with routine screening. If epiretinal membranes cause symptoms such as distortion of central vision or blurred vision, surgery to remove it is recommended.
This is an outpatient procedure that is performed in either a hospital or ambulatory surgery center. During surgery, vitreous is removed and the membrane is peeled from the surface of the retina. The day after surgery, vision is slightly blurred and there is some mild swelling. However, vision gradually improves over the next several days and weeks. Continued improvement can be expected for up to 1-2 years following surgery.
This procedure also accelerates the development of cataracts. Because of this, patients with pre-existing cataracts will often require additional surgery to remove them. However, your doctor may choose to do so prior to or during surgery depending on your individual circumstance.
Vitreomacular Traction Treatment
Vitreomacular traction may or may not cause symptoms and could possibly resolve itself following observation. If vitreomacular traction causes significant symptoms such as distorted or blurred central vision, treatment is recommended.
Surgery for vitreomacular traction is like surgery for an epiretinal membrane because it includes removing vitreous and membrane peeling. If there is splitting within the layers of the retina, an air or gas bubble may be placed in the eye at the time of surgery. This helps the retina return to a more normal contour. Over time, the body reabsorbs this bubble and replaces it with normal fluid.
It is important to remember that a patient cannot travel by air or have anesthesia involving nitrous oxide while the bubble is present. Air and gas bubbles also blur vision completely until they disappear, usually 1-2 weeks following surgery.
There is a small risk of infection, retinal tears, or detachment following this procedure. Close monitoring after surgery will be performed to detect and treat any of these issues should they arise. Overall, these risks are less than 1%.
Despite surgery, some patients, especially those with long-standing epiretinal membrane or vitreomacular traction, will not experience any visual improvement or will continue to have a slight visual decline.