Epiretinal Membrane

Epiretinal membrane (also known as Cellophane Maculopathy or Macular Pucker) is a thin, almost transparent layer of fibrous cellular material which grows over the surface of the retina. Like a layer of plastic wrap or cellophane, it can be basically transparent. In some cases contracture of this thin fibrous tissue can cause wrinkling of the retina, like wrinkles on a bedspread. This conditions is typically a slow-progressing problem that affects the central vision by causing blur and distortion. As it progresses, the traction of the membrane on the macula may cause swelling.

ERM is seen most often in people over 75 years of age. It usually occurs for unknown reasons, but may be associated with certain eye problems such as: diabetic retinopathy, posterior vitreous detachment, retinal detachment, trauma, and many others.

Epiretinal membrane is also known by many other names in clinical and educational circles, including preretinal membrane, idiopathic preretinal macular gliosis, cellophane maculopathy, and surface wrinkling retinopathy.

In early stages, epiretinal membrane may be asymptomatic, or it may create only a mild reduction in acuity. Its progression may cause metamorphopsia and lead to severe visual impairment.

In very severe cases, macular edema and even retinal detachment have been known to occur.

Often, the membranes are seen following posterior vitreous detachment, or they may occur idiopathically in patients over 50 years of age.

Epiretinal membrane formation occurs as a result of retinal glial cell proliferation along the surface of the ILM. Small, focal defects in the ILM allow these cells to "break through" to the retinal-vitreous interface and reproduce, creating a thin veil of tissue. Epiretinal membranes have been found in association with retinal vascular diseases, retinal breaks and detachments, ocular trauma, uveitis, and following retinal cryopexy, laser photocoagulation, and intraocular surgery.

In most cases, little can be done to improve acuity. Most patients, fortunately, suffer only a minimal reduction of acuity or slight metamorphopsia. Reassure patients as to the nature of the disorder and follow up periodically, using an Amsler grid for home monitoring of progression. In severe cases, vision may drop to 20/100 or worse; this may indicate the need for vitrectomy and surgical peeling of the membrane. This procedure is, as one might imagine, very intricate, and is reserved for those patients for whom there are no alternatives.