"Epiretinal Membranes (ERM)," "Macular Pucker" and "Cellophane maculopathy" are all synonyms. These terms refer to a protein deposition on the surface of the retina. I will use the term ERM. The terms have been long standing and one can find various resources using any of these terms. On a microscopic scale, the underlying macula (functional center of the retina) becomes wrinkled (or puckered) and there is a small retinal detachment. The two most common symptoms are decreased central vision and distortion. Usually there is only mild to moderate vision loss. It is not a blinding condition.

In general, this is a relatively benign condition. Patients are prone to forming these membranes and are usually a result of some type of insult or injury to the eye, for instance, previous cataract surgery, trauma, vascular occlusions or a posterior vitreous detachment (PVD). Surgery should be considered if patients are aware of the changes in vision and want the possibility of improvement.

(Illustrations by Mark Erickson, www.JirehDesign.com)

The key to successful therapy is early detection. The goal of surgery, in my opinion, is to prevent further vision loss. Patients should be cautioned about expecting absolute improvement as results vary from individual to individual. Removal of the membrane almost certainly stops further loss of vision, but also, gives the only opportunity for vision improvement. Recurrence can happen less than 5% of the time. I recommend surgery only if the patient is symptomatic.

The membrane itself is very similar to spreading Elmer's glue on the palm of your hand and letting it dry. Remember how you could just peel the dried glue off your hand in one piece? Similarly, small epiretinal forceps will be used to gently grasp the edge of this membrane and peel it off the surface of the retina. This should relieve the traction on the retina and decrease the distortion (metamorphopsia) and possibly improve the vision.

Written by Randall V. Wong, M.D., retina specialist/ophthalmologist, Fairfax, Virginia.

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