Retinal Conditions - Epiretinal Membrane & Macular Holes

Epiretinal membrane, macular pucker, cellophane maculopathy is terminology used to describe thickening of the back layer of the vitreous gel as it adheres to the central area of vision in the retina called the macula.

This is a condensation of the vitreous gel, a Jell-O-like clear substance comprising the bulk volume of the back of the eye, where it contacts with the retinal surface. This layer will sometimes thicken and cause distortion of the macular architecture in eyes after intraocular surgery, trauma, with aging changes, and particularly with episodes of ocular inflammation or diabetic eye disease. Epiretinal membrane is oftentimes associated with distorted or wavy vision as well as blurred vision.

Epiretinal membranes can lead to secondary macular edema.

This can lead to loss of the quality of vision. If the visual acuity is significantly affected with a decrease in clarity of vision or if distortion is bothersome then medical and or surgical intervention can be pursued. Medical treatment involves using potent anti-inflammatories to reduce the swelling. A new medication, Jetrea, uses a naturally derived enzyme to create a separation between the vitreous and the macula more rapidly and safely when the macula is distorted by traction of the vitreous gel. Surgery involves micro-dissection of the scar tissue layer off of the central macula area in a procedure called vitrectomy with membrane peel where the vitreous gel is removed from the eye and replaced by an artificial eye fluid. The surgery is successful more than 95% of the time with an improvement in vision as well as relief of image distortion. Sometimes surgery can be avoided with the use of the medical treatments mentioned.

Epiretinal membrane and traction at the macula can also lead to formation of partial or full thickness macular holes in the retina. This is where the scar tissue sheet pulls on the retina so much that it leads to a partial loss or complete loss of the macular tissue leading to a blurred spot or blank spot in the vision. Partial macular holes are generally observed, as they tend to improve with recovery of visual function; however, macular holes are usually repaired surgically and have a very high success rate (97%) of improvement of vision. The decision-making process for proceeding to surgery will be directed by the retina specialist since recent developments will allow some macular holes to be repaired using office-based techniques. Your RSN doctor uses the latest technology and usually minimizes face-down positioning to 2 days (as opposed to 1-2 weeks) for repair of macular holes.