What is a Membrane peel procedure?
Because there are no drops, medications, or supplements available to treat the symptoms of a macular pucker or macular hole, surgical intervention is the only option. A vitrectomy with a membrane peel is the procedure used to remove a retinal membrane. This common procedure is completed in an outpatient surgery center and takes about 45 minutes. Local numbing around the eye is administered to patients to prevent them from feeling any pain or discomfort during the procedure.
Three small incisions are made through the white part of the eye, known as the sclera, during this procedure. One of the incisions will hold the surgeon’s light source and another will be the vitrector instrument. The vitrector removes the vitreous from the center of the eye by cutting and sucking it out. This will give the retinal surgeon complete access to the back of the eye. Forceps (microscopic tweezers) are then used to gently pull the retinal membrane away from the retina's surface. This relieves any tension on the retina, allowing it to relax. A saline solution is inserted into the eye, and your eye will naturally replace this solution with its own fluid within 24 hours.
Similar surgical steps are taken in the case of patients who have a macular hole. The vitreous space, on the other hand, is filled with gas via an intravitreal gas injection. This gas bubble will hold the retina's edges in place, allowing the macula to return to its original position. Patients who have been injected with a gas bubble will be required to lie face down for several days following surgery. Although often difficult, this positioning allows the gas bubble to press against the back of the eye, assisting the retinal tissue to return to its natural position. For 2-8 weeks, the gas bubble will remain in the eye. Your vision may be cloudy during this time. As the gas bubble naturally reabsorbs, its size will decrease, allowing your vision to gradually return. When the gas bubble is gone, the macular hole usually closes and your vision returns to normal.
Do I Need a Retinal Membrane Peel?
Most patients with a macular pucker have minor symptoms. During routine eye exams, epiretinal membranes are frequently discovered on imaging. Mild epiretinal membranes result in near-normal vision with little distortion. The epiretinal membrane, or "wrinkle," may gradually tighten over time, worsening symptoms. Straight lines or words may be distorted or blurred. Fine print may become difficult to read. Some patients may also experience double vision. It is critical to note that these symptoms are not painful and will not result in total blindness. Retinal membrane peels are an elective procedure that should be performed on patients who are having daily vision problems.
Patients with a macular hole, as opposed to macular pucker, should usually have surgery. The longer you wait to treat a macular hole, the worse your vision will become. It also becomes less likely that the hole will close if surgical intervention is delayed.
What is the Expected Outcome?
Incisions made during surgery are typically self-healing and do not require sutures due to advancements in surgical techniques and instrumentation. This allows for faster healing and less pain after surgery. The patch is removed the next day during the first post-operative appointment. Some people may notice that the white part of their eye appears red, but this will go away after a few weeks. In the first month after surgery, post-operative drops are frequently prescribed to reduce the risk of infection or inflammation. The retina will begin to relax back to its original state during the first few weeks of healing. Vision has gradually improved over several months. The visual improvement from a retinal membrane peel depends on a number of factors. These are some examples:
- Severity of the macular pucker
- The duration of the pucker's presence
- Other eye conditions that coexist
- Retinal membrane peels for epiretinal membranes and macular holes have a high success rate. The majority of patients notice a significant improvement in their vision and a reduction in visual distortion. Improvement in vision after a retinal membrane peel can last several months or even a year.
What Is the Risk of Macular Pucker Surgery?
A retinal membrane peel, like any surgical procedure, has risks that must be considered before proceeding. The following are the most common risk factors for a retinal membrane peel:
- Post-operative infections, also known as endophthalmitis, are possible whenever surgery is performed on the eye. However, retinal surgeons take extra precautions during the procedure to reduce the risk of infection. During the procedure, a sterile technique is used, antibiotics are placed in the eye after surgery, and patients are given antibiotic drops to use while recovering. Despite these precautions, there is still a small possibility of infection. If an infection occurs, it can be treated right away to reduce the risk of permanent vision loss.
- Bleeding - Although blood loss during retina surgery is minimal, another complication that may occur during the procedure is bleeding. Prior to surgery, it is critical to discuss all medications. To reduce the risk of bleeding during surgery, a retinal surgeon may advise you to stop taking any blood thinners.
- Retinal tear or detachment - There is a 1% risk of retinal tear or detachment with vitrectomy surgery. When the gel-like fluid is extracted from the eye, it may take a piece of the retina with it. A 360-degree examination is performed at the end of every vitrectomy procedure to ensure there are no tears or detachments. If this occurs, laser treatment will be performed during surgery to repair the retina. Retinal tears or detachments that develop after membrane peel surgery necessitate a return to the operating room. There is a risk of permanent vision loss, as with any retinal detachment.
- Cataract progression - Patients who have not yet had cataract extraction are at a higher risk of developing a cataract. A vitrectomy procedure can hasten the development of a cataract. Patients who have already had cataract surgery, on the other hand, should not be concerned.