AAn epiretinal membrane (ERM) or macular pucker is an abnormal wrinkling of the retina at the macula. The macula is the central portion of the retina responsible for producing sharp focus and clear central vision. Scar tissue can grow on the surface of the retina; directly over the macula and as this scar tissue contracts it causes the retina to wrinkle.

An epiretinal membrane is typically slow-progressing. Straight lines on picture frames and doorways can often appear wavy. These distortions and blurry vision can affect people in their everyday tasks such as reading or watching TV.

Visual symptoms of epiretinal membranes tend to be worse to start with and then generally settle down and stabilize. This often means that the vision does not deteriorate once they have been present for a year or so. However, in other people the vision may deteriorate as the distorted macula slowly loses the ability to function as well.

In the majority of cases, an epiretinal membrane develops in an eye with no history of previous problems. They are quite common and affect about 10% of people over the age of 70. Occasionally however, an epiretinal membrane will develop in an eye as a result of retinal tears and detachment, trauma, inflammatory disease, or other eye conditions.

If the epiretinal membrane is mild and is having no or little effect on vision treatment is not always necessary. If blurred vision or distortion are causing troubles or the ERM is progressing more rapidly then surgery can be considered.

A Vitrectomy is a surgical procedure where the vitreous gel inside the eye is removed and replaced with the body’s natural saline solution. The membrane can then be peeled away from the surface of the retina. The majority (more than 90%) of patients find the surgery worthwhile. Serious complications from the surgery are rare and well less than 1% would be worse through surgery.

Epiretinal membrane surgery is not an emergency and can usually wait for a while without making a significant difference to the outcome.

Most patients will have a significant improvement in vision after surgery; however this may occur gradually over several months. The amount of visual improvement varies from person to person and depends on multiple factors including the severity of the epiretinal membrane, the level of vision preoperatively, and the presence of any other ocular abnormalities.

OCT images depicting the macula region of a normal retina (above), and an epiretinal membrane (below).

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