Epiretinal Membrane
(ERM)
An Epiretinal Membrane, often called a “macular pucker” or “cellophane maculopathy,” is a delicate layer of scar tissue that forms on the surface of the macula.
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Dr. Bhaskar Gupta
Consultant Ophthalmologist & Vitreo-Retinal Specialist
20+ years experience
Causes
Why it happens ?
- Primary (Idiopathic): The most common cause is the natural aging process of the eye, specifically a Posterior Vitreous Detachment (PVD). As the vitreous gel pulls away from the retina, it can leave behind microscopic remnants of cells on the macular surface. These cells then proliferate and form a thin, transparent membrane which slowly contracts.
- Secondary Causes: ERMs can also develop as a result of other eye conditions or events, including: Previous eye surgeries (e.g., cataract surgery), Retinal tears or retinal detachment, Inflammatory eye diseases (e.g., uveitis), Retinal vascular diseases (e.g., diabetic retinopathy, retinal vein occlusion), Eye trauma.
Incidence
This is a common age-related condition, affecting approximately 7% to 10% of individuals over the age of 60, and its prevalence increases with age, reaching up to 12% in those over 70.
Symptoms
Many ERMs are asymptomatic, especially in their early stages. However, as the membrane thickens or contracts, it can lead to
Blurred or distorted central vision:
This is the most common symptom, making tasks like reading or recognizing faces difficult.
Metamorphopsia
A characteristic symptom where straight lines appear wavy, bent, or crooked (e.g., door frames, utility poles, or lines of text).
Grey or Missing Area in Central Vision
Some individuals notice a faint grey patch or small blind spot in the centre of vision, affecting visual clarity.
Double Vision in One Eye (Monocular Diplopia)
In rare cases, vision may appear doubled in one eye due to distortion of the macula’s normal structure.
Treatment Options
Management of an epiretinal membrane depends on the severity of symptoms and the impact on daily vision. Many cases remain stable and do not require immediate intervention.
Observation
If the ERM is mild, causes no significant symptoms, or has minimal impact on vision, regular monitoring with dilated eye exams and Optical Coherence Tomography (OCT) scans is the recommended approach. Many ERMs remain stable and do not progress to a point requiring intervention.
Vitrectomy and Membrane Peel (Surgical Intervention):
This is the only effective treatment for symptomatic ERMs.
- The Procedure: Performed as a microsurgical day-case procedure, it involves making tiny, self-sealing incisions in the sclera (white of the eye). The surgeon then performs a vitrectomy, removing the vitreous gel. Using specialized micro-forceps and under high magnification, the delicate epiretinal membrane (and often the underlying internal limiting membrane, ILM) is carefully “peeled” away from the surface of the macula. This relieves the traction and allows the retina to flatten.
- Combined Surgery: It is very common to perform Cataract Surgery simultaneously with an ERM peel, especially in patients who have existing cataracts or are over 50. This is because vitrectomy surgery can accelerate the formation or progression of cataracts, and combining the procedures optimizes visual recovery and prevents the need for a second surgery later.
- Visual Recovery: Vision improvement after ERM surgery is gradual. While structural improvement (retinal flattening) occurs within weeks, visual acuity and the reduction of distortion continue to improve for 3 to 6 months as the retinal cells recover and reorganize.