What is an epiretinal membrane?
Some patients develop a thin layer of scar tissue on the surface of the centre of the retina (photographic film at the back of the eye) called an epiretinal membrane (sometimes also called cellophane maculopathy). This thin layer of scar tissue does two things, it impairs the light getting to the retina (causing blurring of central vision) and it contracts (causing wrinkling of the underlying retina with distortion of vision).
This scar tissue formation is often associated with a degenerative change within the jelly that occupies the main eye cavity. The jelly is called vitreous and with the passage of time turns from being jelly like to a more watery consistency. This watery consistency allows cells (including scar tissue cells) to move around more freely inside the eye and the scar tissue cells like to settle on the central part of the retina (macula) where they form a sheet of tissue attached to the retina which then contracts to cause the retina to wrinkle. The treatment for this condition is a surgical procedure called a vitrectomy and membrane peel.
What is the surgical treatment of epiretinal membrane?
Scar tissue can form on the surface of the retina and in particular likes to form at the centre of the retina or macula. This results in a gradual blurring of vision and is often accompanied by distortion of vision as the scar tissue contracts and wrinkles the underlying retina.
The scar tissue can be removed with an operation often termed a “vitrectomy and membrane peel”. In order to gain access to the scar tissue on the surface of the retina the jelly that occupies the main eye cavity (vitreous) has to be removed. The surgery can be under general or local anaesthetic as a day case procedure. It involves creating three very small incisions in the sclera (white of the eye) at the front of the eye and all instruments are placed through these small incisions.
The jelly is first removed and then a fine pair of forceps is introduced into the vitreous cavity to pull away the scar tissue. In most patients the tissue comes away with ease but sometimes the scar tissue can be “stuck” to the retina and comes away in a piecemeal fashion. This type of surgery on the retina is therefore by its nature not as predictable as cataract surgery where up to 99% of patients will get an excellent result. Most patients having surgery for epiretinal membrane will notice an improvement in their vision and a reduction in the amount of distortion. There may however still be some mild visual disturbance even after technically successful surgery. Things can however continue to improve many months after surgery although most of the improvement tends to occur within the first 3 months.
The vitrectomy operation if performed alone will eventually result in the development of a cataract. I therefore routinely perform what is called “combined surgery” for patients with epiretinal membranes. This involves removing the lens of the eye at the time of the vitrectomy surgery and replacing it with a new plastic intraocular lens. This is identical to the cataract surgery which occurs when the lens is cloudy. The advantage of this “combined” approach is that it prevents you having to come back for further cataract surgery months or years after the vitrectomy operation.
Problems we can help with
I will explain with the aid of video clips the various eye problems I treat. This includes cataract surgery, refractive lens exchange in patients over 50 and medical and surgical treatments of all retinal and macular problems.
I provides advanced micro-incision cataract surgery and will advise on the appropriate intra-ocular lens for your particular needs. This includes toric lenses to correct astigmatism and extended range of vision multifocal lenses to reduce spectacle dependance.
Refractive Lens Exchange (RLE)
Patients with strong glasses or contact lenses who's natural lens has lost its ability to focus (usually over 50 years) may benefit from RLE to reduce dependance on glasses or contact lenses. Surgery is beneficial for some but not all patients.
Patients with wet (neovascular) age-related macular degeneration can benefit from prompt injection treatments with various anti-VEGF agents. The first injection can usually be performed on the day of consultation as as "see and treat service".
Retinal Vein Occlusion
Blockage to the veins of the retina can produce significant visual disturbance and may require injection treatments with anti-VEGF agents or steroids at Exeter Eye. More severe cases may require laser or surgery at the West of England Eye Unit under Mr Simcock's care..
Diabetic Eye Disease
Diabetes is becoming increasingly common and can cause significant visual loss. If detected at an early stage vision can be maintained using injection treatments with anti-VEGF agents or steroids. More serious cases may require laser or surgery at the West of England Eye Unit.
Mr Simcock has pioneered macular hole surgery in the UK and performs a technique which includes lens removal to prevent patients returning for cataract surgery. The technique also benefits from no or limited (2 day) face down posturing to allow hole closure in most macular holes.
Scar tissue on the surface of the macular (central retina) causes blurring and distortion of vision. Surgical removal of scar tissue with vitrectomy can be performed if sufficiently troubled. Most patients notice a significant improvement in vision and reduced distortion with this surgery..
Patients troubled by floaters in their vision not improving over a period of at least 6 months may benefit from vitrectomy surgery to remove the floaters. Patient selection is important and depends on age (usually over 50) and the state of the jelly (vitreous) in the main eye cavity.