Epiretinal membrane surgery

The only way to treat an epiretinal membrane is surgery. If a membrane is affecting vision, the only way to treat it is to remove the membrane surgically – eye drops or glasses are not effective. This is done with a procedure called a vitrectomy, where specialized instruments remove the jelly-like substance that normally fills the center of the eye, called the vitreous. Removing the vitreous inside the eye does not cause any permanent damage, except for accelerating the development of cataracts. The vitreous is replaced by natural fluid produced inside the eye. In some cases, the surgeon must leave a special gas bubble inside the eye that disappears on its own after a few weeks. The operation to remove the epiretinal membrane usually takes no more than an hour and can be performed using a local anesthetic, while the patient remains comfortable and awake during the procedure. It is very important for the patient to remain still, especially during the very delicate manipulations when the membrane is removed with fine forceps. After the membrane is removed, the improvement in vision is gradual and it may take months to achieve final vision. The operation is usually successful in reducing the distortion in vision. 

What are the risks of surgical removal of the epiretinal membrane?

Surgery to remove an epiretinal membrane accelerates the development of cataracts, which are a very common cause of vision loss. Sometimes, a cataract may need to be removed at the same time as the membrane removal if it limits the visibility of the membrane. Membrane removal carries a 2% risk of resulting in significantly worse vision and a 2% risk of requiring further surgery to treat the membrane returning or complications of the surgery such as retinal detachment. The risk of serious complications of membrane removal is about 1 in 1000 cases, where the eye becomes completely blind due to bleeding during or after surgery. Some patients may develop high eye pressure, which can damage the optic nerve, causing vision loss. This condition is called secondary glaucoma and can affect 1 in 100 patients after this type of surgery. It may require long-term use of eye drops and, rarely, glaucoma surgery to preserve vision.

Advice after surgery

After surgery, you will be given eye drops to use for a few weeks. The surgery is usually done on an outpatient basis. In some cases, you may be asked to position your head in a certain way for part of the day for several days – called “positioning.” Positioning involves placing your head in a specific position to allow the gas bubble to float in the best position to support the retina. Otherwise, you can do most daily activities, although you should avoid unsanitary environments and anything that puts the eye at risk of injury.

How long will I need to recover?

Most people will need to take one to two weeks off work after surgery. The amount of time off work depends on the type of work you do and the type of surgery being performed. This should be discussed with your surgeon.