Epiretinal membrane
Macular pucker

 

Epiretinal membrane (also known as macular pucker):

  • can significantly reduce vision

  • is treated through a surgical procedure

What is an epiretinal membrane?

  • Also known as “macular pucker”

  • A scar tissue that grows on top of the macula of the retina.

What is the retina?

  • If the eye were a camera, the retina would be the film of that camera

  • The retina is a thin sheet of nerve cells that lines the inside back wall of the eye

  • Light travels through the eye and ultimately reaches photoreceptors, the light-sensitive cells in the retina

  • The signal from the photoreceptors then travel along the optic nerve to the brain, where the signals are interpreted as vision

What is the macula?

  • The macula is the center region of the retina

  • The macula is responsible for high detail vision, central vision, reading, etc. The rest of the retina is responsible for peripheral vision.

  • AMD affects the macula, and in turn, results in decreased vision for tasks like reading, driving, recognizing faces, etc.

The macula (yellow circle shown) is an area in the center of the retina.

How does an epiretinal membrane affect vision?

  • The epiretinal membrane pulls on and wrinkles the macula, distorting the orderly arrangement of photoreceptors and other cells required for high quality, crisp vision

  • Vision symptoms include blur, decreased vision, and distortion (straight lines appearing bent or distorted)

Left: An optical coherence tomography (OCT) scan in a patient with a normal, healthy retina. Notice the downward dip (valley) in the center which represents a healthy foveal dip. The retinal layers are visible as clear dark and light bands. Middle image: A patient with epiretinal membrane (yellow arrow), visible as a thin white sheet of scar tissue draped over the macula and distorting the anatomy. There is no foveal dip present. Right top and bottom images: A thicker epiretinal membrane (yellow arrows) draped over the macula and distorting the anatomy. There is no foveal dip.

Why does an epiretinal membrane form?

  • In most cases, epiretinal membranes form as part of the natural aging process of the eye.

  • Epiretinal membranes may also form in eyes with a history of retinal tear, retinal detachment, inflammation (uveitis), hemorrhage, or prior surgery

How is an epiretinal membrane treated?

  • Observation

    • Appropriate for eyes with mild epiretinal membranes with minimal impact on vision and minimal impact on retinal anatomy

  • Surgery

    • For visually significant epiretinal membranes

What is epiretinal membrane surgery?

  • Pars plana vitrectomy

  • Outpatient, day surgery

  • Micro-incisional surgery whereby the delicate epiretinal membrane is gently peeled off the retinal surface, allowing the retina to assume a more healthy contour (and in turn, achieve an improvement in vision) over time

Left panel: A patient with a thick epiretinal membrane distorting the retina anatomy (left bottom image). The top left image is a retinal thickness map showing areas of significant retinal thickening (red and white) due to pulling from the membrane. Right panel: The same patient 1 week after surgery for removal of the epiretinal membrane. The epiretinal membrane is absent and the retina anatomy is improving with a foveal dip already beginning to form (right bottom). The top right retinal thickness shows a marked reduction in areas of thickening (red).