Q: Can complications occur due to the surgery?
A: Yes, there is a significant incidence of progression of pre-existing cataract after vitrectomy surgery. Some doctors believe that patients with an absolutely clear lens develop cataracts as a result of vitreous surgery, but this has not been proven. The vast majority of patients requiring vitreous surgery for epimacular membranes already have nuclear sclerotic cataracts (yellowing of the center of the lens which occurs commonly with aging), which can worsen after vitreous surgery. Surgeons differ widely on the percentage of patients that suffer cataract progression due to vitreous surgery. A small number of patients (about 1%) will experience recurrence of the membrane after initial success. For these patients the surgery can be repeated with excellent success in most cases. Retinal detachment can occur after vitreous surgery for any reason, including epimacular membrane repair. Opinions vary widely on the frequency of retinal detachment after epimacular membrane surgery, ranging from estimates of 1.5% to 5%.
Q: What is an epimacular membrane?
A: A thin layer of tissue on the front surface of the macula which is the center of the retina and the region responsible for acute vision.
Q: What are the symptoms?
A: They are:
Q: Can epimacular membranes cause total blindness?
A: No, only loss and distortion of central vision.
Q: How common are epimacular membranes?
A: Epimacular membranes are moderately common.
Q: How fast do epimacular membranes progress?
A: Some doctors believe that epimacular membranes progress over many months or even years and gradually worsen vision over this time.
Our doctors have shown that most of the progression takes about one month and then the vision remains stable or decreases slightly.
Q: What are the causes of epimacular membranes?
A: Most epimacular membranes apparently develop due to posterior vitreous separation. Epimacular membranes formed by this process as termed "idiopathic" which means "unknown cause".
Freezing treatment (cryo) or laser treatment used to treat retinal tears and breaks can apparently contribute to the formation of epimacular membranes, although the retinal tears or breaks being treated with these techniques can also cause the formation of epimacular membranes without treatment.
Inflammatory eye diseases can cause epimacular membranes.
Approximately 2.5% of otherwise successful retinal detachment surgeries are followed by the development of epimacular membranes.
Q: Does hardening of the arteries cause epimacular membranes?
A: No, circulation problems have not been shown to have any relation to epimacular membranes.
Q: Are eye strain, nutrition, general health, smoking or emotional stress related to epimacular membranes?
A: No, there is no known relationship between epimacular membranes and any of these problems.
Q: If one eye develops an epimacular membrane, will the other eye develop one?
A: Usually not; most patients develop membranes in one eye only.
Q: What is the treatment for epimacular membranes?
A: Vitrectomy surgery and peeling of the membrane (thin tissue layer) from the retinal surface is required to treat epimacular membranes.
Q: If surgery is not performed, will the epimacular membrane progress?
A: Since the condition usually stabilizes in one or two months with minimal subsequent progession, patients do not need surgery to prevent progression, but only to improve vision.
Q: What are the criteria for surgery?
A: Noticeable distortion of central vision is the most important criterion.
If the doctor makes the patient aware of the problem but the patient does not notice any visual difficulties, surgery is not required.
If the problem affects the patient's ability to work, drive, perform certain recreational activities, read, see medicine labels, or other critical activities, surgery should be considered.
Experienced surgeons operate on patients with 20/40 vision or worse, if the above criteria are met.
The doctor must make certain that there is no other cause of visual loss such as macular degeneration or damage, previous prolonged retinal detachment, or circulatory problems.
Q: Is there a non-surgical treatment for epimacular membranes?
A: No, there is no medicine, eye drop, vitamin, herb, or diet that is beneficial to epimacular membrane patients.
Q: Is there a laser treatment for epimacular membranes?
A: No, only surgery can remove epimacular membranes.
Q: Do epimacular membranes ever disappear without surgery?
A: No, there is no credible evidence for spontaneous disappearance of epimacular membranes.
Q: What drops should be used after vitreous surgery for epimacular membranes?
A: Most doctors use steroid drops, an antibiotic drop, and some use a dilating drop for a few days after surgery.
Q: How long does the surgery take?
A: The procedures usually take less than thirty minutes.
Q: Is the surgery performed on an inpatient or outpatient basis?
A: The surgery is performed on an outpatient basis in all cases unless there is a medical reason to stay overnight in the hospital.
Q: What is the success rate?
A: Visual improvement occurs in over 95% of cases.
The retina is nerve tissue and can require months to fully regain its function. Epimacular membranes cause distortion and wrinkling of the retina which takes time to resolve after removal of the membrane.
There are no medications which can speed this process at present.