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Epiretinal Membrane/Macular Pucker Surgery

Vitrectomy surgery can be used to remove the epiretinal membrane as an outpatient procedure performed under a local anesthetic in much the same way modern cataract surgery is performed. After the placement of the local anesthetic the patient is positioned under a large microscope. During the procedure, instruments are placed in the interior of the eye through three 1.5 mm slit-like incisions in the white of the eye (sclera) a few millimeters away from the colored part of the eye. During the procedure, the eye is maintained in its normal shape by the infusion of fluid. The surgeon views the process using an operating microscope and looking down through the dilated pupil. Light is provided in the eye by a fiber-optic light pipe. First the vitreous is removed using a suctioning cutter. The epiretinal membrane is then removed from the surface of the macula using special forceps. The innermost part of the retina, the internal limiting membrane, is also peeled off the retina to minimize the possibility of recurrence. The tiny wounds usually self-seal, but sometimes are sewn closed. The patient wears a patch and shield over the eye for the first 24 hours. The amount of discomfort experienced following the surgery is usually quite minimal. Most vitrectomies for ERM require less than an hour of actual operating time but may involve several hours overall for registration and  anesthesia.

Results


The visual results of such surgery come slowly. Usually, the vision is worse than preoperatively for at least several weeks following the surgery as the retinal inflammation and edema improve. Improvement over the baseline vision and distortion is usually seen by two to four months, but there can still be improvement for as long as several years following the procedure. Ultimately, a very high percentage of eyes experience a worthwhile improvement in vision and symptoms.

Complications


If the patient hasn’t had cataract surgery yet, there is a high likelihood that in the next several years a cataract will develop in the operated eye. Such cataracts are removed in the same way as ordinary cataracts as an outpatient under local anesthetic. All the other risks are much less frequent. There is a published 1-2% risk of a retinal detachment developing following surgery for an ERM. More than 90% of these detachments are fixable, but require further surgery for the repair. There is a 1 in 10,000 risk of a devastating intraocular infection. There are also lesser risks of transient glaucoma, vitreous and retinal hemorrhage, and some risk that the vision will not be quite as good as it was prior to the surgery even without any notable complication.

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