Epiretinal Membrane Surgery | Pristyn Care

Risk Factors

Risk factors for epiretinal membrane development:

• Age over 50 years – ERM is most common in older adults with age-related PVD
• Prior retinal surgery, laser, or cryotherapy increasing fibrous response risk
• History of retinal vascular disease such as vein occlusion or diabetic retinopathy
• Intraocular inflammation or uveitis causing abnormal cellular proliferation
• High myopia associated with increased vitreoretinal interface abnormalities

Candidacy

ERM surgery is recommended when symptoms significantly affect quality of life, reading ability, or daily activities. Patients with visual acuity of 6/12 or worse, or significant metamorphopsia causing functional impairment, are typically candidates for surgical peeling. Mild ERMs with minimal symptoms are monitored with regular OCT imaging until surgery becomes necessary.

Diagnosis

Diagnostic evaluation for epiretinal membrane includes:

• Optical coherence tomography (OCT) – primary imaging tool for ERM diagnosis and grading
• Best corrected visual acuity testing to assess functional impact
• Amsler grid testing to quantify the degree of central visual distortion
• Fundus examination to assess the extent and severity of retinal wrinkling
• OCT angiography in cases where retinal vascular disease is suspected as the cause

Treatment Options

Pars plana vitrectomy with ERM peeling is the only effective treatment for visually significant epiretinal membrane. No pharmacological treatment dissolves an established ERM. Surgery is elective and timing depends on symptom severity and visual acuity impact. Post-operative visual improvement occurs gradually over 3 to 12 months and is correlated with the duration and severity of the membrane before surgery.

ERM Peeling Surgery Steps

The epiretinal membrane peeling procedure at Pristyn Care involves:

• Retrobulbar anesthesia with IV sedation for patient comfort and a still surgical field
• Pars plana vitrectomy to remove the vitreous gel and expose the retinal surface
• Membrane blue or ICG dye injected to stain and visualize the epiretinal membrane
• Fine forceps or bent needle used to initiate membrane peeling at the membrane edge
• ERM carefully peeled from the retinal surface in a smooth, continuous motion
• Internal limiting membrane (ILM) optionally peeled to reduce ERM recurrence risk
• Fluid-air exchange performed and eye wounds closed at completion of surgery
• Procedure typically completed within 30 to 60 minutes under the operating microscope

Recovery After Surgery

Recovery after epiretinal membrane surgery includes:

• Using prescribed antibiotic and anti-inflammatory eye drops for 4 to 6 weeks
• Avoiding strenuous activity and eye rubbing for 2 to 4 weeks post-surgery
• Vision may initially worsen slightly before improving as the retina heals
• Visual improvement typically begins within 4 to 8 weeks of the surgery
• Final visual recovery and reduction in distortion occur over 3 to 12 months
• Regular OCT imaging to monitor retinal recovery and check for ERM recurrence

Risks and Complications of ERM Surgery

Potential complications of ERM peeling surgery include:

• Cataract formation – very common post-vitrectomy change in patients with natural lens
• ERM recurrence – occurs in 5 to 10 percent of cases requiring repeat surgery
• Retinal tear or detachment as an intraoperative surgical complication
• Macular hole formation – rare but recognized complication of aggressive ILM peeling
• Post-operative inflammation managed with corticosteroid eye drops
• Endophthalmitis – rare but serious infection requiring emergency treatment
• Residual visual distortion despite successful anatomical membrane removal
• Asymmetric binocular vision requiring adaptation time after the operation