Epiretinal membrane

[BUTTERCUP109]

Are epiretinal membranes progressive...ie, do they grow over time?

[JodieJ]

This is a controversial question.  Many authorities say that ERMs can progress months or even years after development, while others say they stabilize within a couple of months.  (This question is addressed at www charles-retina com.)  In most cases, acuity with an ERM does not worsen significantly over time.  However, recent evidence indicates that distortion and loss of stereoacuity do get worse, and the damage to the underlying macular tissue may be irreversible.  Certainly, all ERMs do not need to be surgically peeled.  However, if the ERM causes bothersome symptoms, it is probably better not to delay surgery.

[JodieJ]

I had two surgeries to peel the same ERM.  The old vitrectomy equipment (requiring sutures) was used during my first procedure in 2006.  The surgeon left pieces of ERM in my eye (but never told me), which left me with a larger image size in that eye.  I also had severe suture inflammation postop.  (My surgeon left the suturing to a resident.)  No gas bubble was used.

I had a MUCH better experience earlier this year, when the remaining ERM was peeled by a different surgeon.  The procedure took less than 30 minutes.  It was totally painless, and I was awake throughout.  The 25-gauge, sutureless equipment was used.  Less than 2 hours after leaving the OR, I was having dinner at an Italian restaurant (wearing an eye patch) and feeling fine.  No gas bubble was used, and I had no restrictions.  (I believe that a gas bubble is only used for macular holes and RD.)  The morning after surgery I could read the 20/20 line with my affected eye, although my vision was slightly blurred.  I've gotten about a 50% reduction in my pre-op image size difference.  I'm hoping for more improvement, but the 3+ year delay between my surgeries may have resulted in some irreversible macular damage.  This is why I tell everyone who is considering ERM surgery to make a decision now.

[mike230]

Could you tell me in detail what the ERM peeling involved such as the procedure what recovery was like and what were your restrictions.  How is your quality of vision.  Last year I had an RD with a gas bubble which has been successful.  I had a core vitrectomy performed at the same time.

How long did the procedure last and did you have to have a gas bubble afterward?  Thanks for your input
Mike

[Michael J Kutryb, MD]

Just my simple thoughts.  Yes, sometimes ERM's progress and sometimes they don't.  I would say in my experience maybe 50/50 chance.  When they do progress, usually I don't see major, aggressive amounts of progression but usually more subtle to moderate worsening and at some point they seem to often hit a steady state.

MJK MD

[JodieJ]

According to Dr. Charles, there is little (if any) progression of an ERM after a couple of months.  Other authorities disagree.

I don't want to shake your confidence in your doctor's judgment, but it's been my experience that a doctor's ability to visualize/assess an ERM during a dilated exam may not be accurate.  Several respected retinal specialists failed to identify ERM in my eye, which was subsequently revealed by Spectralis OCT (and then surgically peeled).  Following the surgery, another retinal specialist saw "the glistening of ERM," although my Spectralis OCT images showed a smooth macula.        

[BUTTERCUP109]

When you say that some believe that ERMs can progress after initial development, it raises the question of what is considered to be the initial starting point. I guess what I'm saying is that the process of developing at all may in itself be a progression. Mine was first noted, at least first reported to me, about 6 months ago. My doctor yesterday, seemed to say it was more noticeable now than initially, although very slighty. It seems reasonable that in the presence of an inflammatory process, it might very well progress in response to the inflammatory process. Thanks for your response; I'll certainly look at charles-retina website and try to research it a bit further.