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Epiretinal Membrane (Macular Pucker)

What is an Epiretinal Membrane?

An epiretinal membrane (ERM), also known as macular pucker or cellophane maculopathy, is a condition that affects the retina of the eye. The retina is a thin layer of tissue at the back of the eye that contains light-sensitive cells, allowing us to perceive visual information. The macula is a small area in the retina's centre responsible for central vision and fine detail perception.


An epiretinal membrane is a semi-transparent layer of scar tissue that forms on the surface of the macula. This scar tissue can develop due to various factors, such as aging, trauma, inflammation, or previous eye surgery. The membrane can distort the normal architecture of the macula, leading to vision problems.

Risk Factors and Causes Of Epiretinal Membrane

The exact cause of epiretinal membranes (ERMs) is not always clear. Still, they are thought to develop primarily due to changes in the vitreous humour (the gel-like substance that fills the eye's interior) and subsequent interactions with the retina. Here are some factors that might contribute to the development of ERMs:

  • Age: The risk of developing ERMs increases, particularly in individuals over 50.
  • Vitreous Changes: The vitreous humour can shrink and change as a person ages. In some cases, the vitreous may detach from the retina (a condition known as posterior vitreous detachment), which can lead to scar tissue forming on the retinal surface.
  • Previous Eye Surgery or Trauma: Eye surgeries, such as cataract surgery or retinal detachment repair, can cause inflammation and changes in the vitreous that might promote the growth of scar tissue.
  • Retinal Tears or Detachment: Conditions that lead to retinal tears or detachment can trigger the growth of epiretinal membranes.
  • Inflammatory Conditions: Inflammation within the eye, such as from uveitis, can stimulate the growth of scar tissue.
  • Diabetic Retinopathy: People with diabetes are at an increased risk of developing various eye conditions, including ERMs.
  • Genetic Factors: There might be a genetic predisposition to developing epiretinal membranes, as they sometimes run in families.


Symptoms of Epiretinal Membrane

The symptoms of an epiretinal membrane can vary depending on the severity of the condition, but they often include:

  • Blurred or Distorted Vision: One of the most common symptoms is blurred or distorted central vision. Straight lines may appear wavy or curved, and fine details can be difficult to see clearly.
  • Metamorphopsia: Metamorphopsia is a visual distortion where objects may appear distorted or warped.
  • Reduced Visual Acuity: Central visual acuity may be reduced, making it challenging to read, recognise faces, or perform tasks that require clear vision.
  • Decreased Contrast Sensitivity: Contrast sensitivity refers to the ability to distinguish between objects of varying shades. ERMs can reduce contrast sensitivity, affecting the ability to see objects against a background or in low-light conditions.
  • Central Scotoma: A central scotoma is a blind spot in the central vision that can occur due to an ERM.


How is Epiretinal Membrane Treated?

  • Observation: If the ERM is not significantly affecting vision or causing only mild symptoms, the doctor might recommend regular monitoring without intervention.
  • Vitrectomy: Vitrectomy is a surgical procedure in which the vitreous gel is removed from the eye and replaced with a clear solution. The epiretinal membrane can be peeled off the retina's surface during this procedure. Vitrectomy is often considered if the ERM is causing severe visual distortion or significant vision loss.
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