![]() Several innovative treatments were first developed her, such epiretinal human amniotic membrane grafting for complex macular pathologies. Minimally invasive vitreoretinal surgery within the Tri-state area was first applied at Columbia. Why Choose Columbia?Ĭolumbia is the birthplace for several vitreoretinal surgical techniques. For macular puckers, the vitreous gel is removed, and then a “membrane peel” is performed to remove the scar tissue on the retina. In a vitrectomy, the vitreous gel is removed to prevent it from pulling on the retina and is replaced with a mixture of air and gas that acts as a bandage to heal the hole. In most cases, a surgery called a vitrectomy is recommended. Gray area in the center of vision, or even a blind spot.Ī macular hole can lead to a detached retina if left untreated, so receiving the proper care is critical.Straight lines or objects appear bent or wavy.Since these conditions usually happen slowly, symptoms are often subtly at first. A macular pucker may develop if scar tissue forms where the hole is. With age, the vitreous can shrink and pull away from the retina tissue, causing a hole in the macular area of the retina. The vitreous is a gel-like substance inside the eye that helps keep its round shape. Both macular holes and puckers can cause blurry and distorted vision and are related to aging. ![]() A macular pucker is an extra layer of tissue that forms on the surface of the macula. Rafieetary says, “management success requires consideration of the patient’s overall state of health, physical and emotional status and needs, as well as assessment of all relevant objective and subjective findings.The macula is in the center of the retina and controls central vision or straight-ahead vision used in driving and ready and seeing fine detail. ![]() Neither of these situations are a contraindication for proceeding with the membrane peel. Also, in the absence of a posterior vitreous detachment, the anterior displacement of the vitreous following lens extraction may increase tractional forces, resulting in additional macular morphologic changes. The downside of performing cataract surgery in the presence of an ERM is the increased chance of cystoid macular edema. Also, cataract surgery can improve the retinal surgeon’s intraoperative view for ERM surgery, enhancing the postoperative outcome. The upside in proceeding with cataract surgery before membrane peel is that some patients’ visual function may improve postoperatively to a satisfactory level, in which case ERM surgery may no longer be necessary. But, if the patient’s vision is worse than that and he or she is symptomatic, then surgery may be considered. Many patients with epiretinal membranes-whose vision is in the 20/20- to 20/40 range-never need surgical intervention. “For instance, if the thickest area-likely the epicenter of the membrane-is in an extrafoveal or perifoveal location, it may not alter visual function as much as a broad membrane encompassing the entire macular region, and therefore is not as crucial to address surgically,” Dr. Note the location and extent of the ERM, as well as any other secondary effects such as a hole in the membrane (pseudohole) or tractional foveal schisis, which may result in a different visual outcome. “Having said that, OCT has allowed us to detect and document the most subtle of retinal pathologies, such as epiretinal membranes, particularly in the presence of media opacification.” Just because a patient has a cataract doesn’t mean they don’t have a retinal issue or glaucoma.”Įpiretinal membranes are very common, so look for the glistening sheen of the macula, and distortion and tortuosity of small vessels in the arcade. That is, it’s critical to keep looking beyond the cataract for other conditions. “Both epiretinal membrane and cataract are likely to occur among the aging population, so these two conditions commonly coexist. “We encounter this dilemma frequently,” says Mohammad Rafieetary, OD, who is an associate at a retinal subspecialty practice in Memphis, Tenn. Where does he go from here-to the cataract surgeon or the retinal specialist? The patient was never told of any retinal problem prior, but examination reveals an epiretinal membrane (ERM) in the right eye. Both lenses show 2+ cortical spoking and 1+ nuclear sclerosis, consistent with 20/40. A 64-year-old white male presents for cataract surgery evaluation with best-corrected visual acuity of 20/60 OD and 20/40 OS.
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