Durban Retinal AssociatesDurban Retinal Associates

The Epiretinal Membrane

This is a thin membrane which forms over the surface of the retina, often in the most sensitive part of the eye responsible for vision, called the macular.  This thin membrane contracts and throws the macular into folds, resulting in blurred central vision, often with distortion.  This may cause difficulties with reading, driving, watching television, using a computer and may also cause you to have difficulty in judging distances such as climbing/descending a flight of stairs or pouring a drink.

If the symptoms are severe enough to warrant treatment, then this is achieved with surgery. The decision to have surgery is patient centred and depends on how much the membrane is affecting ones vision and/or quality of life. If one is not really bothered by it one can observe the membrane over time and only operate later if it begins to impede one’s vision (or not at all if it never causes a problem).

SURGERY

Surgery entails removal of the vitreous (jelly) from the back of the eye and the peeling of the membrane from the macula. This is usually performed under general anaesthetic (you will be asleep) and requires a one night stay in the hospital. It is possible to have the procedure under a local anaesthetic if you prefer or if your health prohibits a general anaesthetic.

The vitreous is usually replaced by fluid and in some circumstances we may place a gas bubble in the back of the eye after the surgery.  Should you have a gas bubble in the eye, the vision is initially very poor until the gas is re absorbed by the eye, which might take anything from three to six weeks. During this time it is critical that you do not travel to altitude (or fly) as this will affect the size of the gas bubble and could lead to the expansion of the bubble with disastrous effects on the eye due to increased pressure.

If gas is not used, then,, with a fluid filled eye you will have vision from the first day which initially feels unchanged from prior to surgery (sometimes one may even noticed a slight decrease in vision for the first 3 to 4 weeks).

RECOVERY

The visual recovery from this surgery is slow and usually takes in the region of three to six months with most people still noticing small improvements up to 12 months later. Realistically the eye is seldom 100% normal again, when compared to the fellow eye (assuming that this is normal). Most of the time one can get rid of the annoying central blur (which may see you trying to clean your glasses all the time!) and distortion of vision and make tasks which require judgement of distance a lot easier.

The success rate with surgery is around 70%-ie. 7 out of 10 people experience an improvement in the vision and feel the surgery was worthwhile. This is a lot lower than cataract surgery where the success rate is around 98% so one needs to think carefully about the surgery and understand that the healing process requires patience!

One needs “bedrest” for approximately 1 week and then a slow return to one’s normal level of activity over the next three weeks avoiding strenuous physical exertion or vigorous exercise in this time. Walking (as an exercise) is possible from the 14 days following surgery. During the recovery phase there is no need to avoid using the operated eye and no possibility of overuse or “eye strain” of the fellow eye so reading, watching TV or using a computer are permissible. One only needs to keep the eye covered for the first 5 nights with a shield to prevent inadvertent rubbing. During the day the eye is not covered (unless you wish too) so one’s physical appearance is normal and you could wear your glasses as usual.

If the membrane peel is combined with cataract surgery then one will need to change one’s glasses 3 to 6 months after the surgery depending on how quickly the vision recovers afterwards. If the surgery is done by itself then one may often not need a change of glasses at all. Your doctor will advise you on this during the follow up visits after surgery.

There is usually not much pain following the procedure.  Initially one may feel that the eye is a bit scratchy, but this usually settles very quickly. The vast majority of procedures are performed using a sutureless technique which has dramatically helped speed up the recovery time.  The complications of this procedure include a retinal tear, a retinal detachment, cataract formation and an infection in the eye called endophthalmitis. Severe visual loss or blindness may occur as a complication in 1 in 10 000 cases. These complications will be discussed with you at the pre-operative consultation.