Human eye cross-sectional view. Courtesy NIH National Eye Institute

An Amsler grid, as it might be viewed by a person with very severe Macular pucker. Most cases of Epiretinal membrane are milder and show much smoother curved lines.

Epiretinal membrane is a disease of the eye in response to changes in the vitreous humor or more rarely, diabetes. It is also called macular pucker. Sometimes, as a result of immune system response to protect the retina, cells converge in the macular area as the vitreous ages and pulls away in posterior vitreous detachment (PVD). PVD can create minor damage to the retina, stimulating exudate, inflammation, and leucocyte response. These cells can form a transparent layer gradually and, like all scar tissue, tighten to create tension on the retina which may bulge and pucker, or even cause swelling. Often this results in distortions of vision that are clearly visible as bowing and blurring when looking at lines on chart paper (or an Amsler grid) within the macular area, or central 1.0 degree of visual arc. Usually it occurs in one eye first, and the distortions create binocular diplopia or double vision. The distortions can make objects look higher or wider in the central portion of the visual field, creating a localized aneisokonia that cannot be corrected optically with glasses. In the young (under 50 years of age), these cells occasionally pull free and disintegrate on their own; but in the majority of sufferers (over 60 years of age) the condition is permanent. The underlying photoreceptor cells, rod cells and cone cells, are usually not damaged unless the membrane becomes quite thick and hard; so usually there is no macular degeneration. Image File history File links Human_eye_cross-sectional_view_grayscale. ... Image File history File links Human_eye_cross-sectional_view_grayscale. ... A human eye. ... The National Institutes of Health (NIH) is the primary agency of the United States government responsible for medical research. ... The National Eye Institute (NEI) is one of the US National Institutes of Health that was established in 1968. ... Vitreous humour is the clear gel that fills the eyeball, lying between the lens and the retina in the eye. ... This article is about the disease that features high blood sugar. ... A posterior vitreous detachment (PVD) is an ocular condition in which there is a separation of the vitreous humor from the retina. ... White Blood Cells is also the name of a White Stripes album. ... Scar Tissue is the Red Hot Chili Peppers first single from their album Californication. ... The Amsler Grid, used since 1945, is a black and white grid of horizontal and vertical lines used to monitor a persons central visual field. ... Human eye cross-sectional view. ... Diplopia, commonly known as double vision, is the perception of two images from a single object. ... Double vision may refer to: Diplopia, the perception of two images from a single object. ... Normalised absoption spectra of human rod (R) and cone (S,M,L) cells. ... Normalised absorption spectra of human cone (S,M,L) and rod (R) cells Cone cells, or cones, are cells in the retina which only function in relatively bright light. ... Listen to this article · (info) · play in browser This audio file was created from an article revision dated 2005-07-19, and may not reflect subsequent edits to the article. ...

Surgery for epiretinal membrane

Surgeons can remove or peel the membrane through the sclera and improve vision by 2 or more Snellen lines. Usually the vitreous is replaced at the same time with clear fluid, in a vitrectomy. Surgery is not usually recommended unless the distortions are severe enough to interfere with daily living, since there are the usual hazards of surgery, infections, and a possibility of retinal detachment. A more common complication is high intraocular pressure, bleeding in the eye, and Cataract, which is the most frequent complication of vitrectomy surgery. Many patients will develop a cataract within the first few years after surgery. Schematic diagram of the human eye. ... Hermann Snellen (1834-1908) was a Dutch ophthalmologist who introduced the Snellen chart to study visual acuity (1862). ... Vitreous humour is the clear gel that fills the eyeball, lying between the lens and the retina in the eye. ... Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. ... A cataract is an opacity that develops in the crystalline lens of the eye or in its envelope. ...

Prevention

There is no good evidence for any preventative actions to take, since it appears this is a natural response to aging changes in the vitreous that happen to everyone. It is important to remember that posterior vitreous detachment PVD has been estimated to have occurred in over 75 per cent of the population over 65, that PVD is essentially a harmless condition although with some disturbing symptoms and that it does not normally threaten sight. However, since epiretinal membrane appears to be a protective response to PVD, where inflammation, exudative fluid, and scar tissue is formed, it is possible that NSAIDS may reduce the inflammation response, so taking NSAIDS may be helpful. Usually there are flashing light experiences and the emergence of floaters in the eye that herald changes in the vitreous before the epiretinal membrane forms. A posterior vitreous detachment (PVD) is an ocular condition in which there is a separation of the vitreous humor from the retina. ... An abscess on the skin, showing the redness and swelling characteristic of inflammation. ... An exudate is any thick fluid that is actively secreted by cells as a result of disease. ... Scar Tissue is the Red Hot Chili Peppers first single from their album Californication. ... Wikipedia does not yet have an article with this exact name. ... For other uses, see Floater (disambiguation). ... Vitreous refers to a material in a glassy state. ...

Science background

This ocular pathology was first described by Iwanoff in 1865, and it has been shown to occur in about 7% of the population. It can occur more frequently in the older population with postmortem studies showing it in 2% of those aged 50 years and 20% in those aged 75 years.

The source of the cells in epiretinal membranes (ERM) has been found to comprise glial cells, retinal pigment epithelial (RPE) cells, macrophages, fibrocytes, and collagen cells. These cells are found in varying proportions. Those from retinal breaks, previous retinal detachments, or cryopexy are composed mainly of dispersed RPE cells, while cells of glial origin predominate in idiopathic pathology.

The incidence of associated PVD range from 75-93%, and PVD is present in virtually all eyes with retinal breaks or retinal detachments and subsequent ERM formation. PVD can lead to retinal breaks that may liberate RPE cells that initiate membrane formation. Small breaks in the ILM after PVD also may provide retinal astrocytes access to the vitreous cavity, where they may subsequently proliferate. Finally, vitreous hemorrhage, inflammation, or both associated with a PVD also may stimulate ERM formation.

Both sexes appear to be affected in relatively equal percentages.

Synonyms

Macular pucker, preretinal membrane, cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, premacular fibrosis, and internal limiting membrane disease.

References in Popular Culture

In 1996, Spalding Gray (June 5, 1941 – ca. January 10, 2004), an American actor, screenwriter and playwright, released Gray's Anatomy, a film monologue describing his experiences dealing with a macular pucker and his decision to undergo surgery. It is very funny and quite informative. 1996 (MCMXCVI) was a leap year starting on Monday of the Gregorian calendar, and was designated the International Year for the Eradication of Poverty. ... Gray in Grays Anatomy (1996). ... June 5 is the 156th day of the year in the Gregorian calendar (157th in leap years), with 209 days remaining. ... For the movie, see 1941 (film). ... January 10 is the 10th day of the year in the Gregorian calendar. ... 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... Actors in period costume sharing a joke while waiting between takes during location filming An actor or actress is a person who acts, or plays a role, in a dramatic production. ... Screenwriters, scenarists or script writers, are authors who write the screenplays from which movies and television programs are made. ... Template:Unsourced A playwright, also known as a dramatist, is someone who writes dramatic literature or drama. ... Grays Anatomy is an 80-minute movie directed by Steven Soderbergh in 1996 involving a dramatized monologue by actor/writer Spalding Gray. ...

External links

• Epiretinal membrane, Handbook of Ocular Disease management
• Epiretinal membrane - Macular Pucker, St Luke's Cataract and Laser Institute
• Treatment of Epiretinal Membrane, Mayo Clinic
• Macular Pucker Resource Guide, National Eye Institute
• Epiretinal membrane peeling, EyeMDLink.com

References

• Complications of vitrectomy for non-clearing vitreous hemorrhage in diabetic patients. [PMID: 3231410]
• Pattern VEPs before and after idiopathic epiretinal membrane removal.
• Visual outcomes after pars plana vitrectomy for epiretinal membranes associated with pars planitis.
• Perifoveal vitreous detachment and its macular complications

See also

• Eye surgery