Epirentinal Membranes (ERMs) or macular puckers, are membranes that form on the inner surface of the retina with little to no blood vessels. In the majority of cases, ERMs cause minimal symptoms and can be left alone for simple observation. However, in some cases the macular pucker can cause metamorphopsia, a loss of vision and visual distortion. Generally, ERMs are most symptomatic when affecting the macula, the central portion of the retina that helps us to distinguish fine detail used for reading and recognizing faces. As a result, most patients with ERMs are asymptomatic as the membrane is not affecting the macula.
ERMs that do not affect the macula are usually found incidentally on dilated retinal exams or on retinal imaging such as with ocular coherence tomography (OCT). In these cases, patients typically have normal or near-normal vision. While treatment is not necessary for these cases, it is important to be observant as ERMs can slowly progress, leading to a visual distortion that makes normally straight shapes have a “wavy” or crooked” appearance, especially in comparison to the non-affected eye. In the advanced stages, ERMs can lead to a severe decrease in vision.
As most ERMs become fairly stable after an initial period of growth, they can be monitored as long as the patient is asymptomatic or if symptoms are mild. If retinal imaging shows progression or if there is a worsening in symptoms, surgical intervention may be recommended. For ERMs, there are no medication, nutritional supplements, or eye drops to treat it. Only a surgical procedure called a vitrectomy can resolve cases where eyes require treatment.
With vitrectomy, small incisions are incised in the whites of the eye, and the vitreous gel filling the inside of the eye is replaced with saline. With the saline, access to the surface of the retina is granted where the ERM can be removed, allowing the macula to relax and become less “wrinkled”. Visual recovery is a slow process with most eyes experiencing improvement to their visual acuity within 3 months. It may take up to a year to fully obtain maximal improvements. The risk of complications with vitrectomy is minimal and patients who still have their natural lens will develop increased cataract progression shortly following the procedure.
Citation(s):
Epiretinal membrane surgery. Houston Retina Associates | Houston Texas. (n.d.). https://www.hretina.com/patient-resources/educational-videos/epiretinal-membrane-surgery Assessed and Endorsed by the MedReport Medical Review Board