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What is a Wrinkle on the Retina?

macular pucker
Wrinkle on the retina which is also known as an epiretinal membrane (ERM), or macular pucker, is a thin translucent tissue that develops on the surface of the retina.  The retina is the inner layer that lines the inside of the back of the eye, and is responsible for converting the light image into an electrical impulse that is then transmitted to the brain.  The epiretinal membrane that forms on the retina goes unnoticed by the patient many times and it is only noticed on a dilated eye exam by the eye doctor.   Epiretinal membranes can become problematic if they are overlying the macula, this is part of retina that is used for sharp central vision.  When they become problematic, they can cause distortion of your vision. Objects that are normally straight look wavy or crooked.

Causes

The most common cause is age related due to a posterior vitreous detachment, which is the separation of the vitreous gel from the retina.  The vitreous gel is what gives the eye its shape, and it occupies the space between the lens and the retina.  When the vitreous separates from the retina, this can release cells onto the retina surface which can grow and form a membrane on the macula, leading to an epiretinal membrane.

ERMs can also be associated with prior retinal tears or detachments, prior eye trauma or eye inflammation.  These processes can also release cells onto the retina causing a membrane to form.

Risk factors

Risk increases with age. 

Male and female are equally affected.

Both eye have ERMs in 10-20% of cases.

Diagnostic testing

Most ERMs can be detected on a routine dilated eye exam.

Optical coherence tomography (OCT) is a noninvasive test that takes a picture of the back of the eye.  It can detect and monitor the progression of the ERM over time. 

Treatment and prognosis

Since most ERMs are asymptomatic, no treatment is necessary.  However, if there is significant visual distortion from the ERM or significant progression of the membrane over time then surgical intervention is recommended.  There are no eye drops, medications, or nutritional supplements to treat or reverse an ERM.

The surgery is called a vitrectomy with membrane peeling. The vitrectomy removes the vitreous gel and replaces it with a saline solution.  The epiretinal membrane is then peeled off the surface of the retina with forceps.  Surgery has a good success rate and patients in general have less distortion after surgery. 
For a visual demonstration of a macular pucker watch this video.


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Sunday, 17 October 2021

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