epiretinal membrane

[crazykatie]

I have been told by a retinal specialist that my vision difficulties result from an epiretinal membrane and that if it becomes really bothersome I should have surgery to scrape it away.  As I am a dentist I am quite concerned about the outcome of such surgery.  I have learned online that there are 2 different ways of treating this situation.  Can you explain what they are and which has proven more successful.  What are the potential complications of the surgery?  And finally how would I find the best retinal surgeon in southeast Michigan to do the surgery?

[JodieJ]

I did a lot of research about this before I had my ERM removed during a vitrectomy two years ago.  Other than having a vitrectomy, I'm not aware of any other surgical method for treating an ERM.  (There were past attempts to peel an ERM without doing a vitrectomy, but according to my retinal surgeon the results were poor--many serious problems with floaters post-surgery.)  The best source for a referral is anther ophthalmologist.  

In the majority of cases, no treatment is given for an ERM.  Generally, visual acuity is improved by at least 2 lines on the eye chart post-surgery.  However, the medical literature suggests that the retina is never perfect.  My acuity was restored to 20/20+ in my affected eye, although I have some residual retinal damage that affects image size in that eye.  The most common side effect of a vitrectomy is cataract development, resulting from the lens' exposure to oxygen during surgery.  There is currently new "sutureless" vitrectomy equipment available that will significantly speed up visual recovery in the affected eye.

Perhaps the forum experts can answer other questions.  My best advise if you do decide on surgery is to select an experienced surgeon (definitely not an intern or fellow).  You might want to get more than one opinion before proceeding.  Your surgeon is your best source for information about your particular situation, although you can learn a lot on line.  Best wishes.

[JodieJ]

Re "sutureless" vitrectomy, I'm admittedly prejudiced.  My surgery was done at a teaching hospital, and my surgeon left the suturing to a resident and fellow.  I suffered from severe inflammation post-surgery due to misplaced sutures, and this really slowed down my visual recovery.  The sutures did itch for a time, and their presence in my eye (until they finally dissolved) produced significant astigmatism.  If I had to do it over again, I'd definitely prefer the sutureless equipment.  However, this is the type of surgery where it's really the final results that count.  So the choice of equipment used is best left to the surgeon; there's supposed to be a learning curve involved with using the newer stuff, and some equipment may be better for certain tasks.  (You can read more about this in professional articles online, if you're interested.)

Although it's considered major surgery, it's neither dangerous nor painful.  (I walked over to the local multiplex that afternoon--wearing an eye patch--and stayed for a double feature.  I was feeling fine and wanted to take advantage of the time off work.)  Just about everyone I've interacted with online who has had an ERM removed has had a good outcome.  (The only exception was a woman who had her surgery done outside the US.)

[Michael J Kutryb, MD]

There's a lot of good information already posted.  Suggest  you avoid surgery unless you have best corrected vision worse than 20/40 or so.  There are definitely no guarantees and usually we don't get to know how patients are going to do until 6-9 months post-op (at which time they usually need cataract surgery also due to the fact that the vitrectomy speeds up the cataract development.)  This is a very routine surgery for vitreoretinal specialist so get a consult with one or two of the best in your area to discuss your options.  Don't be enamored by sutureless vitrectomy - from what I have read it is just easier for the surgeon but may have no real palpable benefit for patients and one very lare study showed a significantly higher post-op infection rate in sutureless vs sutured incision.  I would not want sutureless. Woudd just want a very skilled and careful surgeon - interested in the best results.  By the way an OCT scan will show you the erm very well.

MJK MD.

[JodieJ]

Dr. Kutryb, I defer to your superior knowledge about this.  It's been a couple of years since my retinal surgery, which is when I did most of my research on this topic.  At that time there was some preliminary evidence of a higher rate of retinal detachment with the sutureless equipment.  Maybe that didn't turn out to be the case.  The statistically higher risk of infection with the sutureless equipment was always present.  In any case, my visit with a retinal specialist a few months ago led me to believe that the 25-gauge tools are currently used in most of the ERM surgery in my area.  Apparently, there's a learning curve involved in using those miniature instruments, and retinal surgeons might prefer one type of equipment over another, depending on their experience and the nature of the procedure.  If I had to do it over, I'd go with the very best retinal specialist in my area and let him/her use whatever would work best.

[Michael J Kutryb, MD]

Again, I would go easy on making 25 gauge sutureless vitrectomy sound in any way superiour to 20 gauge vitrectomy with suture.  Jan 08 issue of RETINA journal showed much higher incidence of post-op endophthalmitis in sutureless 25 gauge cases versus 20 gauge cases with suture.  Incidence of 11 cases of endophthalmitis in 1307 patients for 25 gauge sutureless  ----- versus --- incidence of 2 cases of endophthalmitis in 6375 cases for 20 gauge sutured group.  ONly one study but that is without out doubt a huge statistical difference.
Both techniques have their place - but there may be more possible drawbacks than benefits to the sutureless technique.  Just my two cents worth.

MJK MD

[JodieJ]

A scleral buckle is a very different procedure than an ERM peeling, and it generally involves a much longer healing time.  My job doesn't involve precise vision, and I could have returned to work in a week, although my suture inflammation looked pretty awful.  Crazykatie, your surgeon would be your best source of information, but you could probably expect to return to work in a couple of weeks.  (Healing time is shorter with the sutureless equipment.)  Although it takes months before the final visual outcome is achieved, your vision in the affected eye should be quite good after a couple of weeks (without complications.)

[Em11]

Although I am unable to comment on your particular retinal problem I would just like to say that I too am a dentist but a post retinal surgery one. I had a detached retina in my  R eye 5 months ago which was repaired by a scleral buckle procedure. Peripheral detachments in my left eye were repaired by laser only. It took 4 months for my sight to settle enough for me to return to work once the binocular vision was restored. It tok a few days for me to get back to working as I had been before the operation as I now have to wear corrective lenses for near work.I wish you well