Treatment of epiretinal membrane (pucker)
An epiretinal membrane is a thin layer of scar tissue that forms on the surface of the retina, usually in the macula. It can cause distorted vision, blurriness or impaired vision and is often treated with a vitrectomy.
Indication for surgery for epiretinal membrane:
1. Reduction in visual acuity:
- A significant decrease in central vision that affects daily functioning, such as difficulty reading or driving.
2. Metamorphopsia (distortion of images):
- When straight lines appear curved or distorted, which is bothersome in activities such as reading or looking at a screen.
3. Progressive symptoms:
- A gradual worsening of vision or increase in distortion, indicating further thickening of the membrane.
4. Macular edema:
- Swelling of the macula caused by the membrane, which can cause further damage to the retina.
5. Severe patient discomfort:
- When the visual symptoms have a significant impact on the patient's quality of life.
Purpose of vitrectomy for epiretinal membrane
A vitrectomy is performed on an epiretinal membrane (ERM) to remove the membrane that has formed on the surface of the retina. This membrane can distort the retina, leading to vision complaints such as distorted vision (metamorphopsia), blurriness or a decrease in visual acuity. The surgery is designed to correct the distortion of the retina and prevent further vision deterioration.
The vitrectomy allows the surgeon to access the retina and carefully remove the epiretinal membrane using fine instruments. By removing the membrane, the retina can return to its normal shape, leading to an improvement in visual acuity and a reduction in visual distortion. Although vision may not always fully recover, the surgery can prevent further deterioration and, in many cases, produce a significant improvement in visual quality.
The decision for surgery is made based on the severity of symptoms, the impact on daily life and the rate at which symptoms worsen.
From 2010 to 2023, Dr. Pion was head of eye surgery at St. Peter's Hospital in Brussels. During these 13 years, he took on the most complex surgical cases and led a team of more than 20 surgeons.
What is a vitrectomy
A vitrectomy is a surgical procedure performed to treat conditions in the vitreous and retina of the eye. The vitreous, a clear gel-like substance that fills the inside of the eye, is partially or completely removed during the procedure. This space is then filled with a special liquid, gas or silicone oil, depending on the type of treatment.
Vitrectomy is used for a variety of eye problems, including retinal detachment, macular surgery (such as an epiretinal membrane or macular hole), severe vitreous hemorrhage or infection, and complications of diabetes of the retina. Removing the vitreous allows the ophthalmologist better access to the retina to repair it or perform other treatments.
The procedure is usually performed under local anesthesia and takes an average of 20 to 60 minutes, depending on the complexity of the problem. Some recovery time may be required after surgery, depending on the filler used and the type of procedure. Vitrectomy is a safe and effective procedure that often leads to significantly improved vision or preservation of vision.
Personalized advice from our experts
Our highly specialized surgeons do a thorough diagnosis and analysis of your eyes. They will discuss all options with you in complete objectivity.
The course of a vitrectomy at Focus Eye Clinic
Step 1: Arrival and preparation at Focus Eye Clinic
Upon arrival at Focus Eye Clinic, you will receive a friendly welcome at the front desk, where our front desk assistants will register and prepare you for your surgery. Next, your pupil will be dilated (dilated) in preparation for the procedure. To make your experience as comfortable as possible, you will be given a relaxation pill. After all, surgery can be exciting, but our dedicated team of three nurses, two healthcare professionals, an anesthesiologist and Dr. Pion will guide you step by step.
Surgeries are always performed under local anesthesia, so you experience no pain and are completely at ease. This is always done under the supervision and guidance of our experienced anesthesiologist, who monitors your comfort and well-being throughout the procedure.
Step 2: Surgery of vitrectomy under local anesthesia (20 minutes - 1 hour)
The vitrectomy is performed under local anesthesia, so you will experience no pain and be completely at ease. The procedure itself takes an average of 20 minutes to 1 hour, depending on the complexity. During the surgery, the eye surgeon removes cloudy vitreous and replaces it with a clear liquid, which improves your vision.
Step 3: Get some rest before heading home
After the vitrectomy, you will be taken care of in our specially equipped relaxation area, where our dedicated nursing team will be there for you. Here you can rest peacefully and receive personalized care and attention. Our team will explain to you step-by-step instructions on postoperative treatment so that you are well prepared for your recovery at home. Once you are comfortable and have received all the information, you may safely leave for home. At Focus Eye Clinic, we strive to make your entire experience, from surgery to aftercare, as pleasant as possible.
How is a vitrectomy performed?
First step: inserting the trocards.
First, 3 separate openings will be made in the hard eye skirt (white sclera). The diameter of these openings is 0.57 mm. Three small tubes are placed in these openings through which the instruments enter the eye.
- At the first hole, the water drip will be placed.
- Through the second hole, the intraocular light will be inserted so that everything can be seen.
- Along the third hole, the vitrectome or intraocular forceps will be inserted into the eye.
Second step: removal of the vitreum
Through the vitrectome, the vitreum will be removed. The vitrectome is a small needle with a microscopic blade (guillotine) on the end. Small pieces of vitreum are aspirated into the vitrectome and cut off through the guillotine blade. Thus, the entire vitreum will be removed.
Third step: Manipulations on the retina
Depending on the condition, work will then be done on the retina. In a retinal detachment, the retina is brought back into place via special fluids. In membrane removals, a blue dye is introduced into the eye and then removed via ultra-fine tweezers. This stage is the most delicate step.
Fourth step: endolaser
To protect the retina from retinal detachment, an endolaser barrage will be performed at 360°. Studies have shown that this greatly reduces the risk of retinal detachment after vitrectomy.
Fifth step: insertion of the glass moisture substitute
Depending on your condition, the vitreous will be replaced with clear water, gas or silicone oil.
- If you eye is filled with gas, you will not see for 2 weeks. This gas may be necessary to keep your retina adjacent or to close a macular hole. However, it refers by itself. YOU MAY NOT TRAVEL BY AIRPLANE AS LONG AS THE GAS IS IN YOUR EYE.
- If your eye is filled with silicone oil you will have blurred vision. Silicone oil will be necessary if gas does not provide sufficient security of healing. Silicone will exert a stronger force on the retina to keep it in place. Silicone oil will always need to be removed with a new surgery.
Final step: closure of the eye
The final step is to close the eye by removing the
trocards. The openings are so small that they usually close by themselves. In
some cases, resorbable threads can be used. They
will disappear on their own after 4 to 6 weeks.
The prognosis of an epiretinal membrane
The prognosis of an epiretinal membrane (ERM) depends on the severity of the condition, the duration of symptoms, and treatment. In many patients, an ERM remains relatively stable and mild membranes cause little or no symptoms, often making surgery unnecessary. In such cases, visual acuity may be well preserved, and the condition usually does not directly affect peripheral vision.
When vitrectomy with membrane peeling is performed to remove the epiretinal membrane, the prognosis is generally good. The goal of the surgery is to improve visual acuity and reduce visual distortions (metamorphopsia). In most patients, there is a noticeable improvement in vision within a few weeks to months after surgery.
Important aspects of prognosis:
1. Improvement in vision:
- Approximately 80-90% of patients experience an improvement in visual acuity and a decrease in visual distortions after surgery.
- The degree of improvement depends on the condition of the retina and how long the membrane was present.
2. Full recovery:
- Although most patients have improved vision, vision rarely fully recovers to its original level, especially if there has been long-term damage to the retina.
3. Stabilization of the retina:
- Surgery helps prevent further damage or distortion of the retina, which favors the long-term prognosis.
4. Macular edema:
- If macular edema was present prior to surgery, recovery of vision may be slower, and the prognosis may be less predictable.
Although the prognosis is good in most cases, the final outcome depends on factors such as the duration of the condition, the degree of retinal distortion and any other eye problems. Regular monitoring and timely intervention are crucial to achieving the best visual outcomes.
Retinal surgeon: Dr. Bart Pion
Dr. Bart Pion, specialist in vitreoretinal surgery, is a leading retinal surgeon with years of experience in complex retinal surgery. He graduated magna cum laude from the Free University of Brussels in 2002, after which he specialized in retinal detachment, macular surgery and other advanced vitreoretinal procedures. Through continuous continuing education and participation in international conferences, he always stays abreast of the latest innovations in retinal surgery.
From 2010 to 2023, Dr. Pion was head of ophthalmic surgery at St. Peter's Hospital Brussels, where he spent 13 years performing the most complex eye surgeries and leading a team of more than 20 ophthalmic surgeons. During this time, he built a strong reputation in retinal surgery, cataract surgery and refractive treatments.
Here he performs vitrectomies, laser treatments and other innovative techniques to restore and protect his patients' vision. Focus Eye Clinic is the only extramural center in Belgium where retinal surgery is performed in an outpatient setting, offering patients fast and efficient treatment without hospitalization. His commitment to precision, innovation and the highest quality care makes him an authority in retinal surgery and vitreoretinal disorders.
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At Focus Eye Clinic, your care is paramount. Our team of nurses, optometrists and assistants work together with one goal: improving your vision. From your first moment of contact to your final checkup, we will guide you with a personalized and caring approach.
A multidisciplinary team for your treatment:
Our experienced multidisciplinary team offers a wide range of ophthalmic treatments. After an initial diagnosis, we refer you to the doctor who best suits your specific needs, ensuring you receive the highest quality of care.
Your personal point of contact:
Throughout the entire procedure, a permanent assistant is available to you. She knows your file inside out and ensures that all your questions are answered quickly and clearly. If necessary, she will put you in direct contact with the right doctor.
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We strive to offer you an appointment within two weeks and plan with you the most convenient time. This efficient system ensures a smooth and personalized experience, allowing you to concentrate fully on your treatment.
A luxurious and comfortable setting at Focus Eye Clinic
At Focus Eye Clinic, we believe that medical treatment should be not only effective, but also comfortable and soothing. Therefore, we have designed our clinic with an eye for luxury and comfort, so that you feel completely at ease from the very first moment.
Our modern and stylish spaces exude calm and confidence, and are designed to provide you with a relaxing experience. From the warm welcome at reception to the comfortable waiting areas and state-of-the-art treatment rooms, every detail has been carefully chosen with your well-being in mind.
At Focus Eye Clinic, we combine advanced technology with luxurious surroundings, so you can enjoy the highest quality care in a setting that exudes peace and confidence. Your health and comfort are our priority, and you will notice that with every visit.
