Dr Ben Wild
Overview |
The retina is located at the back surface of the inside of the eye. Its main function is to detect and transmit the sensation of light to the brain for interpretation. Clinically, the macula refers to the part of the retina that represents the finely detailed central vision.
A frontal view of a healthy eye fundus (back of the eye) where the macula is the dark circle.
An epiretinal membrane (ERM) is formed due to an event that causes the dislocation of glial cells, which normally reside in the inner layers of the retina and optic nerve, and subsequent glial cell multiplication and growth on top of the retina. These cells band together to create a membrane that resembles plastic, or cellophane, wrap. Other names for this condition include cellophane maculopathy and macular pucker. If this membrane continue to thicken, it can pull the retina in many different ways leading to the wrinkling of the retina and macula and can distort vision.
A frontal view of an eye with an epiretinal membrane showing wrinkling of the macula and blood vessels.
Signs and Symptoms |
Signs
Translucent membrane on retina, wrinkling of the retina and blood vessels on the retina, partial retinal hole, and rarely, hemorrhages (bleeding).
Symptoms
Often asymptomatic, possible blurry vision, distorted vision (straight lines appear to bend).
Causes and Risk Factors |
Causes
Dislocation and growth of glial cells on top of the retina, more specifically, the macula. They are often idiopathic (no known cause) but there are many events that can lead to the formation of an ERM (see risk factors).
Risk Factors
Intra-ocular inflammation (inflammation inside the eye such as uveitis or vasculitis), intra-ocular surgery (cataract surgery, retinal surgery, etc.), posterior vitreous detachments, retinal hole formation, retinal tear formation, retinal detachments, retinal dystrophies.
Prevention and Treatment |
Prevention
There are no known preventative measures.
Treatments
· Majority of cases do not need treatment as they often do not affect vision or only affect vision minimally.
· Membrane peel surgery and vitrectomy (removal of the vitreous humor gel inside the eye).
Prognosis |
In most cases, epiretinal membranes do not need treatment and vision remains strong. If vision is affected, surgery has been shown to improve vision by at least 2 lines on a reading chart in 75% of cases, produce no benefit in 23% of cases and actually leads to poorer vision in 2% of cases.
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