From the Guidelines
Surgery for epiretinal membrane is necessary when the condition causes significant visual symptoms that interfere with daily activities and quality of life, such as decreased visual acuity, metamorphopsia, double vision, or difficulty using their eyes together, as indicated in the 2020 study by 1 and 1. The primary indications for surgical intervention include:
- Decreased visual acuity, typically when vision drops to 20/60 or worse
- Distorted vision (metamorphopsia) that affects reading or recognizing faces
- Double vision in one eye
- Central vision blurring that doesn't improve Surgery should be considered when these symptoms persist and worsen over time, rather than for mild cases with minimal symptoms. The surgical procedure, called vitrectomy with membrane peeling, involves removing the vitreous gel and carefully peeling away the abnormal membrane from the retina's surface, as described in the study by 1. This outpatient procedure typically takes 30-45 minutes under local anesthesia. Most patients experience gradual visual improvement over 3-6 months following surgery, though complete restoration to normal vision isn't always possible, with approximately 80% of patients with ERM or VMT improving by at least two lines of visual acuity following vitrectomy surgery, as reported in the study by 1. The decision to undergo surgery should be individualized, weighing the severity of symptoms against potential risks such as cataract progression, retinal tears, or infection, as discussed in the study by 1. Early consultation with a retina specialist is recommended when symptoms begin interfering with daily activities, as timing of intervention can impact visual outcomes.
From the Research
Indications for Surgery
Surgery for epiretinal membrane is necessary in cases where the condition causes significant visual loss and/or metamorphopsia. The decision to undergo surgery is typically made when the symptoms are severe and interfere with daily life 2.
Benefits of Surgery
Studies have shown that surgery can improve visual acuity and reduce metamorphopsia in patients with epiretinal membrane. For example, one study found that visual acuity improved by a mean of 0.31 logMAR units (three lines of vision) after surgery, with 83% of patients experiencing an improvement of two lines or more 3. Another study found that subjective visual disturbance, as measured by a visual analogue scale, decreased significantly after surgery, with patients experiencing more subjective benefit if they had more disturbance at baseline 4.
Complications of Surgery
While surgery can be effective in improving vision, it is not without risks. Complications of epiretinal membrane surgery can include intraoperative hemorrhage, retinal tears, and postoperative progressive nuclear sclerosis, retinal tears causing detachments, macular edema, and retinal pigmentary epitheliopathy 5. However, most complications can be managed successfully, and the final visual acuity is not significantly affected, except in cases where retinal detachment involves the macular area.
Timing of Surgery
The timing of surgery is important, as delaying surgery can result in worse outcomes. One study found that the preoperative visual acuity, metamorphopsia scores, and central foveal thickness were prognostic factors for the corresponding postoperative values, suggesting that surgery should be considered before severe reduction in visual acuity or metamorphopsia occurs 6.
Key Points
- Surgery is necessary for epiretinal membrane when symptoms are severe and interfere with daily life
- Surgery can improve visual acuity and reduce metamorphopsia
- Complications of surgery can occur, but most can be managed successfully
- The timing of surgery is important, and delaying surgery can result in worse outcomes
- Preoperative visual acuity, metamorphopsia scores, and central foveal thickness are prognostic factors for postoperative outcomes 2, 3, 4, 5, 6