*Please note that this information is for illustrative purposes only, providing a general overview on the topics listed. For any specific questions or concerns regarding your condition, please contact our office so that you can consult with the appropriate person or department to address your needs.
Epiretinal Membrane (ERM)
An epiretinal membrane (ERM) is a condition that is caused by the abnormal growth of cells on the surface of the macula (the center of the retina when your fine vision comes from). ERMs typically form with age after a posterior vitreous detachment (PVD) occurs (see section on PVD). As the vitreous separates from the retina, cellular debris can settle on the macula and begin to grow into scar tissue that can contract, leading to puckering and distortion of the macula. This pucker and distortion will often lead to decreased and distorted vision.
An epiretinal membrane can often be associated with a recent retinal tear or detached retina. Development of a tear or detachment can allow cells that are normally trapped under the retina (retinal pigment epithelial cells) to gain access to the vitreous cavity through the tear or break in the retina. These cells land on the macula and grow into an ERM over time.
Subtenon’s steroid therapy (typically Kenalog/triamcinolone or dexamethasone) is another conservative option to treat the CME associated with puckering and distortion of the macula from the contraction of the ERM.
Some of the risks of subtenon’s triamcinolone or dexamethasone therapy include elevation of intraocular pressure, more rapid cataract progression, localized tissue atrophy and droopy eyelid on the side of injection.
This is not a complete list of risks but includes some of the more common side effects of these medications.
The surgery is performed through three 25-gauge ports (about the width of a wire paper clip). The surgery begins by placing an infusion canula, a light pipe & a vitrectomy cutter through each of the 3 ports. The infusion cannula keeps a constant pressure in the eye while the vitrectomy cutter removes the vitreous gel. As the gel is removed, balance salt solution replaces the gel in the vitreous cavity. If the gel is adherent to the retina, it is gently lifted off the optic nerve and macula to separate the vitreomacular adhesions. The light pipe is used by the surgeon to see the vitreous being removed inside the eye. The surgeon will then stain the ERM and ILM with indocyanine green dye (ICG) and peel the ERM and ILM (in some cases). After the ERM (and ILM) are removed the surgeon removes the surgical instruments and trocars (3 ports) and the operation is complete. No sutures are typically needed in up to 95% of cases. Antibiotic ointment and a patch are placed over the eye for one night and removed the following day by the technician in our office.
Some of the risks of vitrectomy surgery include:
• More rapid cataract progression (in up to 20% of patients the lens may harden or become cloudy more rapidly after the vitreous gel is removed) that may require cataract surgery 1-2 years after the vitrectomy procedure.
• Vitreous (less than 5%) or choroidal (less than 1%) hemorrhage
• Retinal break or tear (less than 5%) or Retinal Detachment (less than 1%)
• Infection/Endophthalmitis (less than 1 in 500 patients)
• Permanent loss of vision/Blindness (approx. 1 in 10,000)
• These are some of the more common or severe complications but this is not a complete list of every complication
*Please note that this information is for illustrative purposes only, providing a general overview on the topics listed. For any specific questions or concerns regarding your condition, please contact our office so that you can consult with the appropriate person or department to address your needs.
Epiretinal Membrane (ERM)
Overview
An epiretinal membrane (ERM) is a condition that is caused by the abnormal growth of cells on the surface of the macula (the center of the retina when your fine vision comes from). ERMs typically form with age after a posterior vitreous detachment (PVD) occurs (see section on PVD). As the vitreous separates from the retina, cellular debris can settle on the macula and begin to grow into scar tissue that can contract, leading to puckering and distortion of the macula. This pucker and distortion will often lead to decreased and distorted vision.An epiretinal membrane can often be associated with a recent retinal tear or detached retina. Development of a tear or detachment can allow cells that are normally trapped under the retina (retinal pigment epithelial cells) to gain access to the vitreous cavity through the tear or break in the retina. These cells land on the macula and grow into an ERM over time.
Symptoms
An ERM causes a slow onset of blurred, decreased or distorted central vision. Patients often notice distortion of straight lines (rpi-ag). Some patients complain of distortion of letters or numbers when they read. Other patients complain of glare from car headlights when driving at night.Treatment
The treatments for a epiretinal membrane (ERM) include medical [topical nonsteroidal anti-inflammatory drugs (NSAIDS) and subtenon’s steroid therapy] and surgical options (Vitrectomy surgery). Only a vitrectomy procedure to remove the ERM can definitively address the patients’ symptoms. The medical options can only treat the cystoid macular edema (CME is swelling in the retina from the puckering and distortion caused by the ERM).Current Medical Treatment Options
Topical nonsteroidal anti-inflammatory drugs (NSAID) therapy is often used by physicians to attempt to reduce the swelling in the macula (CME) that develops from the puckering and distortion of the macula that forms from contraction of the ERM. Topical NSAID therapy often can stabilize or improve a patients’ vision just enough to allow the patient to comfortably perform their activities of daily living. Some patients may be able to delay, or avoid entirely, surgical intervention to remove the ERM if topical NSAIDs are effective.Subtenon’s steroid therapy (typically Kenalog/triamcinolone or dexamethasone) is another conservative option to treat the CME associated with puckering and distortion of the macula from the contraction of the ERM.
Risks of Medical Treatments
The risks of topical NSAID therapy include slow or delayed healing of corneal epithelial defects, sulfite allergic reactions, increased bleeding from ocular tissues and corneal epithelial keratitis.Some of the risks of subtenon’s triamcinolone or dexamethasone therapy include elevation of intraocular pressure, more rapid cataract progression, localized tissue atrophy and droopy eyelid on the side of injection.
This is not a complete list of risks but includes some of the more common side effects of these medications.
Surgical Treatment Options
Vitrectomy surgery with physical separation of epiretinal membranes (ERM), and sometimes peeling of the internal limiting membrane (ILM) is the gold standard for treatment of ERMs. The procedure is performed under local anesthesia in either of the outpatient surgical centers used by our physicians (Essex Specialized Surgical Institute, http://www.essexsurgicalinstitute.com/ OR Ramapo Valley Surgical Institute, http://www.rvscnj.com/) or a local hospital.The surgery is performed through three 25-gauge ports (about the width of a wire paper clip). The surgery begins by placing an infusion canula, a light pipe & a vitrectomy cutter through each of the 3 ports. The infusion cannula keeps a constant pressure in the eye while the vitrectomy cutter removes the vitreous gel. As the gel is removed, balance salt solution replaces the gel in the vitreous cavity. If the gel is adherent to the retina, it is gently lifted off the optic nerve and macula to separate the vitreomacular adhesions. The light pipe is used by the surgeon to see the vitreous being removed inside the eye. The surgeon will then stain the ERM and ILM with indocyanine green dye (ICG) and peel the ERM and ILM (in some cases). After the ERM (and ILM) are removed the surgeon removes the surgical instruments and trocars (3 ports) and the operation is complete. No sutures are typically needed in up to 95% of cases. Antibiotic ointment and a patch are placed over the eye for one night and removed the following day by the technician in our office.
Risks & Benefits of Surgery
The benefits of vitrectomy surgery are the potential for improved vision, reduction or elimination of the distortion of straight lines and reduction or elimination of floaters.Some of the risks of vitrectomy surgery include:
• More rapid cataract progression (in up to 20% of patients the lens may harden or become cloudy more rapidly after the vitreous gel is removed) that may require cataract surgery 1-2 years after the vitrectomy procedure.
• Vitreous (less than 5%) or choroidal (less than 1%) hemorrhage
• Retinal break or tear (less than 5%) or Retinal Detachment (less than 1%)
• Infection/Endophthalmitis (less than 1 in 500 patients)
• Permanent loss of vision/Blindness (approx. 1 in 10,000)
• These are some of the more common or severe complications but this is not a complete list of every complication
*Please note that this information is for illustrative purposes only, providing a general overview on the topics listed. For any specific questions or concerns regarding your condition, please contact our office so that you can consult with the appropriate person or department to address your needs.