Risks associated with Epiretinal membrane surgery

[BUTTERCUP109]

In my previous question regarding surgery risks, you listed cataract,retinal detachment and 10% risk of CME. I have had previous lens replacement that cuts cataract risk to zero and prophylactic cryoplexy to my peripheral retina that should greatly reduce but not eliminate RD risk. However, I do have long-standing CME (2 years) with some leakage showing on FA. The severity is mild at present. Could the CME flair up and be even more severe and difficult to control if I have the membrane peeled? What does the fact that there is some leakage on the angiogram say about the the cause of my chronic CME? As was the subject of the previous question, does leakage correlate to the ERM as a causative factor?

[BUTTERCUP109]

Thanks for the help. You seem to have more specific information than any retina specialist I've talked to. Can you give me sources of information such as published articles or names of ophthalmologists with special interest in this area? To reply to your comments, my ERM is very slight, barely visable superior to the macula and does not show a membrane on the OCT. My CME fluctuates between 320 and 480 thickness at the macula.  I have already had many, many Avastin and steroids and can't have more steroids due to IOP issues, so I'm at a dead end as far as pharmacological treatments.

[Ray T Oyakawa, MD]

Chronic CME can cause ERM changes.  It really depends on the severity of the ERM.  If the CME is out of proportion to the ERM, then a peel may not help.  Long standing CME is not a good prognostic sign.  I would consider Avastin and or steroid injection and possibly an Ozurdex implant.  The CME can get worse after a peel.

Dr. O.