Further Outpatient Care
- It is important to monitor patients long term because of reoccurrence of the condition.
Complications
- Intraoperative
- The most frequently encountered intraoperative complications with vitrectomy and membrane peeling include intraocular bleeding and the development of retinal breaks.
- Petechial hemorrhage along the internal retinal surface may be seen as the membrane is peeled off the retina but usually resolves within days of the operation.
- More significant bleeding is encountered when an underlying vessel is damaged as a strongly adherent membrane is being peeled. This bleeding usually can be controlled by raising the intraocular pressure temporarily and waiting for the vessel to stop bleeding spontaneously or by applying cautery on the offending vessel.
- The development of retinal breaks is the most important intraoperative complication that may be encountered. The incidence of intraoperative posterior pole breaks ranges anywhere from 0-15%, while that of peripheral breaks ranges from 5-6%.
- Meticulous peeling of the membrane and careful examination of the peripheral retina are the most effective means to minimize postoperative problems associated with these retinal breaks.
- Postoperative
- The most frequent postoperative complication that may be seen is the accelerated progression of nuclear sclerosis of the lens, which may occur in as many as 75% of eyes over time.
- Most patients have to undergo cataract extraction within 2 years to maximize the benefits afforded by membrane peeling.
- Postoperative retinal detachment may be caused either by a missed break or by a new break that developed after further contraction of the remaining anterior vitreous. This detachment happens in 3-6% of patients and nearly always is treated successfully by another operation.
- Recurrence of EMM happens in less than 5% of idiopathic cases but may be higher for postdetachment and postinflammatory cases.
Prognosis
- Numerous studies have addressed the potential benefit of surgery to remove the EMMs. These studies have looked at the quantification of the postoperative visual acuity improvement as well as the subjective improvements through postoperative quality of life questionnaires. They have also looked at other prognostic factors that may influence visual outcomes.
- Surgical removal of clinically significant EMMs usually results in improvement in both visual acuity and biomicroscopic appearance of the retina. Studies have shown that, postoperatively, 78-87% of patients with IEMM and 63-100% of patients with postdetachment membranes improved at least 2 Snellen lines. Patients with poorer preoperative vision tended to improve the most, but those patients with better preoperative vision obtained the best final results.
- Visual acuity has also been evaluated through the use of postoperative questionnaires. A large-scale study showed that surgery improved the symptom of distortion the most, with moderate-to-severe symptoms most improved. Improvement was also seen in other daily tasks, such as reading small print.
- Sometimes, however, the metamorphopsia may persist despite improvement in visual acuity. This is seen mostly in cases where there is incomplete peeling of the membrane. On the other hand, there are cases wherein the distortion is improved but the Snellen acuity remains unchanged. This mainly is encountered in cases where there is long-standing macular edema.
- The presence of new or accelerated cataract formation has been shown to occur in the surgical treatment of EMMs.
Chang LK, Fine HF, Spaide RF, et al. Ultrastructural correlation of spectral-domain optical coherence tomographic findings in vitreomacular traction syndrome. Am J Ophthalmol. Jul 2008;146(1):121-7. [Medline].
Bovey EH, Uffer S. Tearing and folding of the retinal internal limiting membrane associated with macular epiretinal membrane. Retina. Mar 2008;28(3):433-40. [Medline].
Karacorlu M, Ozdemir H, Senturk F, Karacorlu SA, Uysal O. Correlation of retinal sensitivity with visual acuity and macular thickness in eyes with idiopathic epimacular membrane. Int Ophthalmol. Jun 2010;30(3):285-90. [Medline].
Gupta P, Sadun AA, Sebag J. Multifocal retinal contraction in macular pucker analyzed by combined optical coherence tomography/scanning laser ophthalmoscopy. Retina. Mar 2008;28(3):447-52. [Medline].
Gupta OP, Ho AC, Kaiser PK, et al. Short-term outcomes of 23-gauge pars plana vitrectomy. Am J Ophthalmol. Aug 2008;146(2):193-197. [Medline].
Gupta OP, Weichel ED, Regillo CD, et al. Postoperative complications associated with 25-gauge pars plana vitrectomy. Ophthalmic Surg Lasers Imaging. Jul-Aug 2007;38(4):270-5. [Medline].
Charles S. Epimacular Membranes. In: Guyer DR, Yannuzzi LA, Chang S, et al. Retina-Vitreous-Macula. Vol 2. Philadelphia, Pa: WB Saunders Co; 1999:230-7.
Haritoglou C, Gandorfer A, Gass CA, et al. The effect of indocyanine-green on functional outcome of macular pucker surgery. Am J Ophthalmol. Mar 2003;135(3):328-37. [Medline].
Casparis H, Bovey EH. Surgical treatment of lamellar macular hole associated with epimacular membrane. Retina. Oct 2011;31(9):1783-90. [Medline].
Hillenkamp J, Saikia P, Herrmann WA, et al. Surgical removal of idiopathic epiretinal membrane with or without the assistance of indocyanine green: a randomised controlled clinical trial. Graefes Arch Clin Exp Ophthalmol. Jul 2007;245(7):973-9. [Medline].
Garweg JG, Bergstein D, Windisch B, et al. Recovery of visual field and acuity after removal of epiretinal and inner limiting membranes. Br J Ophthalmol. Feb 2008;92(2):220-4. [Medline].
Gass JDM. Macular dysfunction caused by epiretinal membrane contraction. In: Stereoscopic Atlas of Macular Diseases: Diagnosis and Treatment. Vol 2. 4th ed. St. Louis, Mo: Mosby; 1997:938-950.
Haritoglou C, Gandorfer A, Schaumberger M, et al. Trypan blue in macular pucker surgery: an evaluation of histology and functional outcome. Retina. Aug 2004;24(4):582-90. [Medline].
Marghero RR. Epiretinal macular membranes. In: Albert DM, Jakobiec FA, eds. Principles and Practice of Ophthalmology. Vol 2. Philadelphia, Pa: WB Saunders Co; 1994:919-925.
McDonald HR, Schatz H, Johnson RN. Introduction to epiretinal membranes. In: Ryan SJ, ed. Retina. Vol 2. 2nd ed. St. Louis, Mo: Mosby; 1994:1819-1825.
Russell SR, Crapotta JA. Macular epiretinal membranes. Ophthalmol Clin North Am. June 1993;6(2):239-45.
Sjaarda RN, Michels RG. Macular pucker. In: Ryan SJ, ed. Retina. Vol 3. 2nd ed. St. Louis, Mo: Mosby; 1994:2301-2312.
Ting FS, Kwok AK. Treatment of epiretinal membrane: an update. Hong Kong Med J. Dec 2005;11(6):496-502. [Medline].
Wong JG, Sachdev N, Beaumont PE, et al. Visual outcomes following vitrectomy and peeling of epiretinal membrane. Clin Experiment Ophthalmol. Aug 2005;33(4):373-8. [Medline].
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