Hello, this is easy-to-understand ophthalmology story.
Today’s topic is “the retinal membrane”.
It is a disease that is called by various terms such as epiretinopathy, epimacular membrane, and epimacular membrane.
If you have just been diagnosed with an ophthalmologist, what kind of disease is this and how to manage it?
You may be wondering if surgery is possible in the future.
Although the epiretinal membrane is a very common disease, there seems to be a lack of explanations that can be easily accessed by patients.
epiretinal membrane definition
The epiretinal membrane is literally the membrane before the retina .
Epiretinopathy can be seen as a disease in which a membrane forms before the retina .
In the same way, it is also expressed as the epiretinal membrane.
In English, the front Epi, the retina of the retina, and the membrane of the membrane are combined.
It is called the epiretinal membrane (ERM) .
The retina is a thin tissue that covers the inside of the eye and acts like a film in a camera.
You can think of it as easily staining the film .
In particular , it is often referred to as the premacular membrane because it occurs frequently in the “macula,” which is the central center of the retina.
It is a disease in which a sticky, opaque film like a white spider web is formed on the retina as shown in the figure above.
Of course , your eyesight will decrease and various problems will arise, right?
Now let’s find out why it occurs, how to manage and treat it .
Causes and classification
Why does an epiretinal membrane form?
According to the cause, it can be divided into three main categories.
Occurs without any ophthalmic disease or lesion that may be a specific cause
Occurs due to ocular diseases such as retinal vascular disease, inflammation in the eye, retinal tear, trauma, etc.
Caused by any type of eye surgery, including retinal detachment and cataract
The epiretinal membrane is mostly idiopathic and occurs without any association with other systemic or ophthalmic diseases.
It is usually common in people over the age of 50 and its prevalence increases with age .
The prevalence of idiopathic epiretinal membrane occurring without a cause is 7-11%, which is a relatively common disease .
Looking at the prevalence of epiretinal membrane due to ophthalmic surgery
4-8% after retinal detachment surgery
1-2% after retinal laser treatment
It is reported in 9.1% after cataract surgery, but this may vary depending on the patient’s age or disease state before surgery.
mechanism of occurrence
Why does a film suddenly form in front of the retina?
The epiretinal membrane is a fibrous, avascular tissue that is sticky like a cobweb.
The egg white-like tissue that fills the eye, called the “vitreous ,” is inherently transparent.
The orthodoxy is that the cells of the vitreous are deformed and proliferate abnormally, forming a fibrous, sticky membrane .
The aging process of the vitreous, which is always mentioned, plays a part in causing this phenomenon to occur without any cause.
The vitreous, which filled the inside of the eye with elastic jelly-like shape, ages and
From about 40, it loses elasticity and begins to change like water (vitreous liquefaction)
The vitreous, which was attached to the retina at the back of the eye, is detached from the retina as shown in the figure above (posterior vitreous detachment).
The vitreous body falls from the retina and retinal cells release inflammatory substances due to microscopic damage to the retina.
It is secreted into the vitreous, and the vitreous cells undergo degeneration and abnormal proliferation and form a membrane on the retina .
Therefore, retinal tears, detachments, or other diseases in the eye can also cause this kind of epiretinal membrane, right?
Symptoms of the retinal membrane are
It varies depending on the location, thickness, and deformation of the retina caused by the membrane.
If the membrane is very thin and does not deform the retina, you will have near-normal vision .
Therefore, it is often asymptomatic and found during health examinations.
As time passes, the film thickens and deforms the retina, resulting in decreased vision and deformed (wavy appearance) symptoms .
Epiretinal membrane is a disease of the retina.
Retinal examination is important for diagnosis .
In order to observe the retina well , a drug is put in the eye to enlarge the pupil (mydriasis), and the examination is performed .
Direct observation of the retina through a slit lamp microscope can identify the epiretinal membrane.
If you look at the picture above, you can see that the center of the retina (macula) is covered with something white and shiny .
This is the epiretinal membrane and, in mild cases, it may not be well identified with this type of microscopy.
Optical coherence tomography (OCT) is a precise examination of the retina that uses light to make a very accurate diagnosis .
The normal macula has a concave shape as shown in the figure above.
However, when the epiretinal membrane is formed , the concave shape is deformed together with the thick membrane in front as shown in the figure above.
The above are OCT findings according to the advanced stage of the epiretinal membrane.
In stage 1, there is only a thin film in front of the retina, and the concave shape of the macula is maintained.
As the stage progresses, the membrane thickens, the shape of the macula is distorted, and edema can be seen.
When you reach stage 3 or 4, your eyesight will deteriorate and the deformity will be severe, right?
Because the epiretinal membrane is very slow even if there is no change in most cases after it occurs
Because symptoms are mild and vision remains stable for a long time, surgery is not required.
However, if the membrane gradually thickens and deforms the retina, surgical treatment is required.
Usually , surgery is considered when the deformity is severe or the visual acuity drops below 0.4.
As the times advance and the demands on vision increase, there is a tendency to have surgery earlier .
Surgery is a method to directly remove the membrane .
An operation called “vitreous resection” is performed .
For more information on vitrectomy, please refer to the link below .
In case of epiretinal membrane without severe retinal deformation or edema
Visual acuity usually increases by 0.2
Rather, it is important to know that immediately after the operation, the visual acuity is lower than before the operation, and it takes 4 to 6 weeks for the vision to be restored immediately before the operation and 3 to 6 months for the vision to improve .
It is a disease in which the effect of surgery appears very late.
However, in the case of epiretinal membrane accompanied by other ophthalmic diseases other than idiopathic epiretinal membrane, the prognosis may vary depending on the situation.
Q and A
- Is epiretinal membrane a disease that cannot be prevented?
does not exist. It is best to make early detection through regular ophthalmic examinations and then observe whether the epiretinal membrane worsens.
- Does the epiretinal membrane need surgery?
Surgery is not required for idiopathic (no cause) epiretinal membranes, as most do not cause major problems with vision or retina.
However, if the shape of the retina is changed or the patient’s symptoms are difficult, surgical removal is required.
- Is there no drug treatment?
Currently, surgical removal is the only option.
- Can the epiretinal membrane cause blindness?
Blindness is difficult with idiopathic epiretinal membrane.
It is very deep, pulling the retina and severe deformation of the macula can cause distortion in central vision, but it is not easy to cause deterioration of vision in the periphery.
- What are the complications of surgery?
All common vitrectomy complications can occur.
Learn more about the epiretinal membrane.
My mother also has a very mild epiretinal membrane and is currently under follow-up.
Maybe someday I’ll have to have surgery.
Epiretinal membrane can be a relatively simple operation, but it depends on the degree and accompanying diseases.
It can be a complex and difficult operation.
We hope that early detection through ophthalmic examination and regular follow-up will not miss the time of surgery.
Thanks for reading this long post,
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