What Is a Membrane Peel (ERM Surgery)?

How Do Surgeons Use "Vital Dyes" to Identify the Membrane?

Because the epiretinal membrane is nearly transparent and thinner than a human hair it is extremely difficult to see with the naked eye. Surgeons use specialized dyes such as Brilliant Blue or Indocyanine Green to stain the membrane. The dye sticks only to the scar tissue or the "Internal Limiting Membrane" allowing the surgeon to see exactly where to grasp. This staining technology has increased the safety of the procedure by nearly 50 percent because it reduces the risk of the surgeon accidentally grasping the healthy underlying retina.

What are the Primary Success Data Trends for Visual Distortions?

Clinical data indicates that the primary success of a membrane peel is the reduction of "metamorphopsia" which is the warping of straight lines. Statistics show that nearly 90 percent of patients report that lines look straighter within six months of surgery. However the improvement in "clarity" or 20/20 vision is often more gradual. Data suggest that visual acuity typically continues to improve for up to one year after the peel as the retinal cells slowly return to their original positions after being released from the tension of the scar.

Why Is OCT Imaging Mandatory for Pre-Surgical Planning?

Optical Coherence Tomography (OCT) is the tool that provides the definitive data needed to recommend a membrane peel. The scan shows a cross-section of the retina revealing the exact thickness of the membrane and the amount of traction it is putting on the macula. If the OCT shows "intraretinal cysts" or a "lamellar hole" surgery is prioritized to prevent the damage from becoming permanent. Data show that patients who have surgery when their vision is still 20/50 or better have a significantly higher success rate than those who wait until their vision drops to 20/200.

What are the Specific Risks of Cataract Progression After Peeling?

A side effect of the "vitrectomy" required for a membrane peel is the rapid development of a cataract. Statistics show that nearly 80 percent of patients will develop a significant cataract within two years of having retinal surgery. This occurs because the removal of the vitreous gel changes the oxygen levels around the eye's natural lens. Due to this high correlation many surgeons recommend a "combined" procedure where the cataract is removed at the same time as the membrane peel to save the patient from a second surgery later.

How Do Clinicians Measure "Retinal Sensitivity" Following a Peel?

To track the success of the healing process doctors often use "Microperimetry" to test the sensitivity of the macula. This test measures how well each individual point on the retina can detect light after the scar tissue is gone. Data indicate that while the retina looks flat on a scan within weeks the "electrical sensitivity" takes much longer to recover. Identifying areas of persistent "numbness" in the macula allows the clinician to provide realistic expectations for the patient's final reading ability.