Vitrectomy with membrane peel is the most common vitreoretinal surgery. The procedure is typically performed to intervene in the event of epiretinal membrane (ERM) formation or vitreomacular traction syndrome that presents with visually significant symptoms.
An ERM is a semitranslucent, avascular, fibrocellular membrane located along the inner surface of the retina’s internal limiting membrane (ILM). In most instances, ERM formation is seen over or around the macula. Clinically, you may document a loss of foveal reflex, parafoveal light reflection (which looks similar to cellophane), wrinkling of the retinal surface, localized intraretinal hemorrhages or alteration of the parafoveal vasculature (increased tortuosity). Macular edema and/or pseudoholes may also be associated with ERM development.
Some ERM patients are asymptomatic; however, most affected individuals report distorted vision or scotomas that are repeatable on Amsler grid testing. Because some ERMs slowly worsen over time, patients typically experience a gradual reduction in visual acuity.
The first clinical sign of ERM formation tends to be an unnatural macular appearance. Although fluorescein angiography can be used to help diagnose ERM, OCT has become the gold standard; its high-resolution imaging of the vitreoretinal interface detects even the subtlest membrane.
In vitrectomy with membrane peel procedures, the instruments are usually inserted 4mm behind the limbus. The surgery is performed under local anesthesia with very small incision ports that do not require suturing. Visual recovery varies from patient to patient, but can be dramatic the very next day.
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