Dr Simon ChenCataract & Retina SurgeonAn epiretinal membrane is a thin sheet of scar-like tissue on the macula that can blur or distort central vision. Many are simply monitored with OCT scans; vitrectomy with membrane peel is considered when the change affects everyday life.
Normal retina and epiretinal membrane. The pale surface membrane can wrinkle the macula beneath it. Its appearance and effect on vision vary.
Enlarge diagramAn epiretinal membrane is a thin sheet of scar-like tissue on the surface of the macula—the part of the retina used for reading and recognising faces.
What causes an epiretinal membrane? →
As the membrane contracts, it can wrinkle the retina beneath. Straight lines may look bent, print can become harder to read, and vision may feel different between the two eyes.
Reading, distortion and everyday tasks can tell us more than the vision chart alone.
OCT shows the membrane and the shape of the retina, and helps us measure change over time.
Many membranes can be monitored. Surgery is considered when its likely benefits outweigh the risks for your eye.
Further explanation: Why can vision still look distorted after epiretinal membrane or macular hole surgery?.
Tiles, door frames, window bars and lines of print look wavy or kinked, and objects can seem the wrong size or shape in the affected eye.
The centre of vision softens over months, so small print and faces lose their sharpness. Glasses do not remove distortion caused by the membrane, although they may help other focusing problems.
Most people notice the problem in one eye, often when the other is covered. The good eye tends to compensate, which is why the change can go unnoticed for a while.
An OCT scan (optical coherence tomography) maps the layers of the macula in cross-section, showing the membrane and the wrinkling beneath it.
After a vision test and dilating drops, the macula is examined and scanned. The scan is repeated over time to measure change, which guides the decision about whether and when to operate. Because the lens sits in front of the retina, any cataract is assessed at the same time; the two often need to be planned together.
Dr Chen explains what the scan shows and whether watching, or surgery, is the sensible next step for that eye.
The operation is called vitrectomy with membrane peel. It is delicate, precise work under the microscope, usually as day surgery.
Through three tiny openings in the white of the eye, the vitreous gel is removed (a vitrectomy). The membrane is then lifted off the surface of the macula with fine forceps, often after a dye is used to make it visible. The openings are usually small enough to seal without stitches. A gas bubble is sometimes placed in the eye at the end; for a membrane alone it is often not needed.
Surgery is under local anaesthetic with sedation, or general anaesthetic when that suits the person. Dr Chen is a retinal surgeon and regularly performs membrane peel surgery.
Dr Chen performs membrane peel surgery with the Alcon UNITY Vitreoretinal Cataract System (VCS) through tiny self-sealing openings. A specialised dual dye stains both the membrane and the thin inner layer of the retina beneath it, so they can be clearly seen and completely removed under high magnification.
About the technology in Dr Chen’s practice
Complications are uncommon but include infection, bleeding, retinal tear or detachment, raised pressure and, rarely, loss of vision. A cataract commonly develops or advances after vitrectomy in eyes that still have their natural lens, so cataract surgery is often planned alongside. Distortion usually improves but may not disappear, and vision continues to settle for months. All of this is discussed with you before surgery.
Improvement is gradual. Vision after a membrane peel continues to settle over months rather than days.
Report any sudden loss of vision, increasing pain or redness, or a new shadow in the vision rather than waiting for the next appointment.
Published in mivision · May 2020
Read an article about epiretinal membranes written by Dr Simon Chen with Dr Chris Hodge, covering assessment and treatment in more detail.
No. Many are mild and stable, and are simply watched with OCT scans. Surgery is considered when the membrane is affecting vision in a way that matters to you.
Distortion often improves after surgery, but some can remain, particularly when a membrane has been present for a long time. What is realistic for your eye is discussed candidly before surgery.
Often, yes. Vitrectomy accelerates cataract in eyes that still have their natural lens. Because Dr Chen performs both, the cataract can be planned at the same operation or in sequence, whichever suits the eye.
Regrowth after a peel is uncommon. The eye is reviewed with OCT after surgery to confirm the macula has settled.
No. A membrane sits on the surface of the macula; a macular hole is a small gap in the centre of it. They are related, sometimes occur together, and are both treated with vitrectomy, but the decisions differ. See the macular hole page.
Longer articles by Dr Chen go into these questions in more detail, including what the research shows.
Appointments and enquiries are made through Vision Eye Institute Chatswood.
Level 3, 270 Victoria Avenue, Chatswood NSW 2067Optometrists, GPs and ophthalmologists can refer through Oculo or with the PDF referral form.
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