Patient information – vitreo-retinal service

Epiretinal membrane
Your eye doctor has told you that you What causes an epiretinal membrane?
have an epiretinal membrane. You In most cases, there is no underlying
might want to discuss the information cause for the epiretinal membrane. It is
with a relative or carer. If you require an thought to happen because the vitreous
operation, we will ask you to sign a (jelly inside the eye) pulls away from
consent form, so it is important that you the retina. This most commonly
understand the information in this happens to people over the age of 50.
leaflet before you agree to go ahead The membrane may also form following
with surgery. If you have any eye surgery or inflammation inside the
questions, we suggest you write them eye.
down so you will remember to ask one
of the hospital staff. How will an epiretinal membrane
affect my vision?
What is an epiretinal membrane? Often the scar tissue does not affect
If you think of your eye as a camera, your vision. However, sometimes it can
the retina is like the photographic film. and when it contracts (shrinks) it
It is a very thin layer of tissue, which is causes distortion of your central vision
sensitive to the image focused on it, – for example, straight lines appear
sending information to the brain. wavy or crooked, and reading is difficult.
At the very centre of the retina is the Depending on the severity of this
macula. This is a very special area of distortion, you might notice a
the retina, which we use for reading substantial loss of central vision with
and recognising complex shapes. blurring. In some cases, patients only
Sometimes, scar tissue forms which notice symptoms when one eye is
grows across the macula. If this scar covered –for example during an eye
tissue contracts, it may cause distortion test at the optician.
of the retinal tissue. In some cases,
this contraction may also affect the How is an epiretinal membrane
vision, particularly when reading and treated?
doing other visually demanding tasks. The only way to treat an epiretinal
Left untreated, this condition will not membrane is by having an operation.
cause total blindness. Eye drops or glasses will not help.

This information can be made available in alternative formats, such as easy read
or large print on request. Please call PALS: 020 7566 2324/ 020 7566 2325 1
Should I have surgery for my supervision of an experienced surgeon,
epiretinal membrane? a junior surgeon might perform some,
Your doctor will help you to decide if or all, of your operation.
surgery is appropriate for you. The You will need an operation called a
main reason to proceed with the ‘vitrectomy’. Vitrectomy operations are
operation is to attempt correction of the keyhole surgery for the eye. The
distortion of your central vision. If you surgeon makes tiny openings, less than
are not aware of any visual problems, 1mm across, in your eye and removes
you might not need to have surgery. the vitreous from inside. Your surgeon
However, if the distortion affects your will then grasp and gently peel away
ability to work, drive, read, or perform the epiretinal membrane from the
other important activities, you should retina. Sometimes we put small stitches
consider having an operation. on the eye. These dissolve naturally
Some patients decide not to have an over about four to six weeks. At the
operation and accept the distorted end of the operation, we usually put a
central vision in the affected eye. This pad and shield over your eye to protect
is reasonable, especially if the vision in it. These will be removed the morning
the other eye is not affected. There is after your surgery.
no “right” or “wrong” decision, as every
person has different needs and After your operation
priorities. Your eye will feel uncomfortable, gritty,
and itchy and might appear red or
Will the problems get worse if I leave bruised – this is normal for 7- 14 days.
it? Paracetamol can be taken for pain relief
Not necessarily. In general, you should every four to six hours. Your eye will
only go ahead with surgery if you find take two to six weeks to heal, but your
the distortion of your vision troublesome vision may continue to improve for
at the moment, and not as a several months. You will be reviewed in
preventative measure. clinic about two weeks after the
operation. We will give you eye drops
Your surgery and we will explain how and when you
Most epiretinal membrane surgery is should use them. This is to reduce any
performed under a local anaesthetic but inflammation, give your eye some rest
some are done under general and prevent infection. Please don’t rub
anaesthetic. The details of anaesthesia your eye as this may increase
will be given to you separately, and is infection and lead to complications.
available on our website:
http://www.moorfields.nhs.uk/content/h When to seek advice
aving-operation While a certain amount of discomfort is
The operation will be performed by an normal after the surgery, you should
experienced surgeon. Often, under the contact the hospital immediately if you
have any of the following symptoms:

Moorfields Eye Hospital NHS Foundation Trust

City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk 2
 • A lot of pain that is not relieved bubble of gas or air into your eye to
with paracetamol- this can prevent any damage occurring.
sometimes be a sign that the eye However, if you did experience a retinal
pressure is high. detachment, you would need to have
• Loss of vision another (different) operation to repair
• Increasing redness of the eye the detached retina and prevent sight
loss in the affected eye. There is a
You can receive information and advice 1:1000 chance of total loss of vision
from experienced ophthalmic-trained (blind eye) and a 2-5% chance of
nurses by calling Moorfields Direct reduced vision after this type of surgery.
telephone helpline (details can be found
below).
In the case of an emergency, please If we put a gas or air bubble in your eye
attend your local A&E department or you must not fly for the periods of
Moorfields A&E, which is open 24 time specified below. This is because
hours a day, seven days a week. the gas or air bubble will expand in size
and thus can lead to raised pressure
What improvement in my vision can I inside your eye, leading to visual loss.
expect after the operation?
After an epiretinal membrane is We use three types of gases:
removed, vision gradually improves • C3F8 which is long acting and can
over a period of three to six months in stay in your eye for up to 12
70%-80% of patients. However, in weeks.
some cases vision may not improve • SF6 which can stay in your eye for
following surgery, due to damage up to four weeks.
already caused by the membrane. In • C2F6 which can stay in your eye
about 10% of patients, the membrane for up to eight weeks.
may return, which will cause the visual
problems to recur. Surgery usually • Air – which can stay in your eye for
improves the vision in the affected eye, up to two weeks
but it will never be completely normal. You will be told after your surgery which
type of gas bubble was used.
What are the side effects of surgery? It is important to note that the gas can
A vitrectomy operation can cause small react with another gas called nitrous
tears to form in the delicate structure of oxide, which can cause problems in
the retina, which may cause the retina your eye if any is administered. Nitrous
to move away from its normal position oxide is commonly used during
at the back of the eye (retinal childbirth and in A&E as pain relief.
detachment). Sometimes, the surgeon Please tell the midwife or A&E staff
can see this problem starting during the treating you (or ask your family to) that
vitrectomy operation, and will put a you have gas in your eye and that they

Moorfields Eye Hospital NHS Foundation Trust

City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk 3
should not administer any nitrous
oxide. Should you need a general Moorfields Eye Hospital NHS
anaesthetic for any reason during this Foundation Trust
time it is important that you also tell the City Road, London EC1V 2PD
anaesthetist that you have had surgery Phone: 020 7253 3411
and gas in your eye. www.moorfields.nhs.uk

If gas is inserted into your eye during Moorfields Direct telephone helpline
the vitrectomy operation, you may have Phone: 020 7566 2345
to posture (keep your head in a certain Monday-Friday, 8.30am-9pm
position) after the operation while the Saturday, 9am-5pm
gas bubble dissolves. During this time, Information and advice on eye
your sight will be blurred. A member of conditions and treatments from
staff will provide you with a posturing experienced ophthalmic-trained nurses.
leaflet to assist you with this or you can
view it on our website.
Patient advice and liaison service
The likelihood of getting a cataract
(PALS)
(where the lens in your eye becomes
Phone: 020 7566 2324/ 020 7566 2325
cloudy) increases after a vitrectomy, so
you might need surgery for this Email: moorfields.pals@nhs.net
Moorfields’ PALS team provides
condition sometime in the future.
confidential advice and support to help
you with any concerns you may have
Useful contacts about the care we provide, guiding you
o Advanced nurse practitioner, through the different services available
vitreo retinal service at Moorfields at Moorfields. The PALS team can also
City Road advise you on how to make a complaint.
Opening times: Monday –
Thursday, 7.30am-5.30pm Your right to treatment within 18
Phone: 020 7253 3411, bleep 417 weeks
o Staff nurse, vitreo retinal service Under the NHS constitution, all patients
Opening times: Monday- have the right to begin consultant-led
Thursday, 7.30am-5.30pm treatment within 18 weeks of being
Phone: 020 7253 3411, bleep 422 referred by their GP. Moorfields is
o Mackellar ward based at committed to fulfilling this right, but if
Moorfields Eye Hospital in City you feel that we have failed to do so,
Road, open seven days a week please contact our patient advice and
Phone: 020 7566 2590 liaison service (PALS) who will be able
Author: Yvonne Kana, advanced nurse practitioner, VR to advise you further (see above). For
service more information about your rights
Revision number: 5 under the NHS constitution, visit
Approval date: July 2020
Review date: July 2023 www.nhs.uk/choiceinthenhs

Moorfields Eye Hospital NHS Foundation Trust

City Road, London EC1V 2PD
Phone: 020 7253 3411
www.moorfields.nhs.uk 4