The distortion of the retina by the ERM can cause damage to the peripheral, or outer, retina, or to the photoreceptors (primarily the cones) in the macula. An ERM can, in some cases, significantly affect vision, but it is not macular degeneration and it does not cause blindness. Some surgeons also peel the internal limiting membrane (ILM) during ERM surgery to confirm complete removal of the ERM, based on studies suggesting that ERM recurrence may be lower in eyes with a peeled ILM. Vitrectomy surgery, which involves removing the vitreous as well as peeling the ERM, is performed when the ERM is causing significant visual impairment. In other cases, however, the ERM can cause significant traction, or pulling, on the underlying retina (called macular pucker), which in turn can alter the structure of the retina enough to cause distortion in vision (such as straight lines appearing wavy), areas of central vision that are blurry, or decreased visual acuity. In some cases, it can worsen over time, causing blurring and distortion of central vision. Often, an ERM is transparent and has no, or minimal, effect on vision. The ERM is abnormal tissue caused by a proliferation of various types of cells from the retina and other parts of the eye. Epiretinal Membrane or Macular PuckerĪn epiretinal membrane (ERM) is a thin, transparent sheet of fibrous (or scar) tissue that occasionally develops on top of, and attaches to, the surface of the internal limiting membrane. ![]() This removal is very challenging surgery but has greatly improved anatomical and functional results.įor more information about this technique for macular hole surgery, see Meet Antonio Capone, Jr., MD, and His Pioneering Work in Face-Down Positioning after Macular Hole Surgery. Several years ago, retinal surgeons started peeling/removing the internal limiting membrane during surgery for most macular holes. The internal limiting membrane (ILM) is a thin, transparent, porous membrane lying between the retina and the vitreous and forming a boundary between them. Please be certain to have a thorough and informed discussion with your ophthalmologist and surgeon about the most appropriate treatment for your specific eye condition.įor more information about macular holes, see Surviving Recovery from Macular Hole Surgery. Please note: There are differing opinions and ongoing research regarding the preferred treatment for lamellar macular holes, ranging from observation to surgical treatment. A macular hole should not be confused with macular degeneration or a retinal detachment.Ī major component of surgical repair for macular hole involves removing the vitreous traction or tugging on the macula through microscopic instruments inserted through microscopic holes in the white part of the eye, called the sclera. When the hole is only partial thickness, it is referred to as a lamellar hole. Peripheral (or side) vision is not affected. ![]() This tug-of-war can cause a hole in the macula, the area of clearest central vision in the retina.Ī retinal hole results in visual symptoms that can range from blurriness or distorted vision to small areas of “missing” vision in the central vision to significantly decreased central vision. Essentially, a tug-of-war takes place, with the body of the vitreous shrinking while the “stubborn” fibers hold tight to the retina. In isolated cases (about three per 1,000 people over the age of 60), some resilient fibers refuse to let go of the retina. As people age, the vitreous starts to shrink and pull away from the retina. The eye is filled with a gel-like substance called the vitreous, which helps maintain the shape of the eye. I’ve also included a short summary for easier reference. Here are some terms that can help to explain macular pucker/epiretinal membrane, macular pseudoholes, and the ways they differ from macular holes.
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