Epiretinal membraneGold Coast & Tweed Heads

Dr Weaver performs surgery for epiretinal membranes, including complex cases and repeat operations. He consults at Robina and Tweed Heads and operates at Miami Private Hospital, Tweed Day Surgery and Pacific Private Hospital.

An epiretinal membrane is a thin, see-through layer of scar tissue that grows on the surface of the macula, the centre of the retina that you use for reading and fine detail. It is also called a macular pucker. As the membrane tightens, it wrinkles the retina underneath, a bit like cling film shrinking on a surface. This blurs and distorts your vision.

Most membranes form after the gel inside the eye separates from the retina with age (a posterior vitreous detachment). They can also follow a retinal tear, retinal detachment surgery or inflammation. Often there is no clear cause.

• Straight lines look wavy or bent (metamorphopsia)
• Blurred central vision
• A ghost image or double vision in that eye
• Trouble reading, especially small print
• Things look smaller than they should (micropsia)
• Symptoms usually come on slowly, over months to years

An OCT scan, a quick and painless photo of the layers of the retina, shows the membrane and how much it is wrinkling the retina. This helps decide when surgery is worthwhile.

Not every membrane needs surgery. Mild membranes that do not bother you much can simply be checked with scans and vision tests. Surgery is considered when:

• The distortion is affecting your daily life
• Your vision has dropped a lot
• Scans show the membrane is getting worse
• It is getting in the way of driving, reading or work

Dr Weaver will look carefully at your symptoms, vision and scans before recommending surgery. The right time is different for each person.

The operation is done as day surgery. The eye is numbed and you are given sedation to relax you. It usually takes 30 to 45 minutes.

• Vitrectomy: the gel inside the eye is removed through three tiny openings, each less than 1 mm, so the surface of the retina can be reached.
• Peeling the membrane: using very fine instruments and high magnification, the membrane is gently lifted off the retina. This needs great care so the retina underneath is not damaged.
• Peeling the inner layer: in most cases Dr Weaver also peels a very thin layer on the surface of the retina (the internal limiting membrane). A dye makes it visible. This lowers the chance of the membrane coming back.
• At the end: a small air bubble is often left in the eye to help the openings seal. It goes away within a few days. A long-lasting gas bubble is not usually needed, and you will not routinely need to keep your face down.

Vision improves slowly, over 3 to 12 months, as the retina flattens out and recovers. Most people notice less distortion and clearer vision. Vision does not always return completely to normal, especially if the membrane has been there for many years or has damaged the retina.

The aim of surgery is to stop things getting worse and to improve vision. It may not make your vision perfect. Dr Weaver will talk with you about what to expect, based on your own scans.

You will not routinely need to keep your face down. If a small air bubble was left in the eye, your vision will be blurred for a few days until it goes, and you must not fly until it has gone. Do not rub the eye, and avoid swimming and heavy lifting for 2 weeks.