Epiretinal Membrane

Understanding Epiretinal Membranes

An epiretinal membrane (ERM), also known as macular pucker or cellophane maculopathy, is a thin layer of scar-like tissue that forms on the surface of the macula, the central area of the retina responsible for detailed vision. This translucent membrane can contract over time, causing wrinkling and distortion of the underlying retinal tissue. Patients typically notice gradual blurring of central vision, distortion of straight lines (metamorphopsia), and occasionally double vision.

Epiretinal membranes are relatively common, particularly in people over 50 years of age. They may develop without obvious cause or secondary to conditions such as retinal tears, previous retinal surgery, inflammation, or vascular disease. Most ERMs progress slowly, though the rate and extent of visual impairment varies considerably between individuals.

Natural History and Observation

Not all epiretinal membranes require treatment. Many remain stable or progress very slowly, causing minimal visual symptoms.  Patients who retain good vision and minimal distortion may choose conservative management, as their quality of life remains largely unaffected.

The decision to proceed with surgery is usually a balance of the degree of visual impairment against the small but definite risks of the intervention.

Surgical Treatment

Vitrectomy with membrane peeling is the definitive treatment for symptomatic epiretinal membranes. The surgery involves removing the vitreous gel and carefully peeling the membrane from the macular surface using microsurgical instruments. .

Success rates for ERM surgery are high, with over 90% of patients experiencing visual improvement or stabilization. The aim is to improve vision, reduce distortion, allow the two eyes to work better together and prevent any further deterioration. The vision does not return to normal. Visual recovery is also gradual, often taking several months as the retina slowly flattens and macular anatomy improves. Patients with better preoperative vision and shorter symptom duration typically achieve better outcomes.

Combined Procedures

Performing a vitrectomy for an epiretinal membrane will often cause a cataract or cause existing cataract to worsen.  It is therefore usual to consider the pros and cons of combined cataract surgery with epiretinal membrane surgery.   

Mr Laidlaw is highly experienced in both assessing the need for and treating epiretinal membrane.