Stephen Lash Eye Surgery

23G Phaco vity Peel for Epiretinal Membrane.mp4 23G Phaco vity Peel for Epiretinal Membrane.mp4
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Here is a full operation but sped up 8x! Each stage is annotated so you get the idea. This is my standard technique for ERM. Surgery is under local anaesthetic and is very comfortable.
Here is a typical ERM although like stripping wallpaper sometimes you get a bit and it keeps coming in one piece and sometimes it comes off in bits. That feeling you get when you strip a decent bit of wallpaper is a similar feeling I get when I get a good one! Very satisfying.

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What is an epiretinal membrane (ERM)?

Epiretinal membrane is a membrane on the surface of the retina at the centre.The retina is the light sensitive film of the camera that is the eye. The centre of the retina is called the macula and in the middle of this area is the fovea which is a tiny dip in the retina and the only place any of us can see detail (Just look at a clock now and then look 1m to the side, you can no longer see the numbers!) The membrane grows over the surface and then contracts. It is like grabbing a bed sheet with your hand and then closing your fist, the bed sheet rucks up into many folds. You can imagine that if the retina is thrown into folds light gets distorted and the vision becomes blurred (If you shine a strip of light on the bed sheet the light will appear to twist and turn).

Why has this happened?

The main cause is idiopathic (which means we do not know) although now with modern imaging tools such as OCT, we now know the Jelly separates from the centre of the retina first and it may be in this separation some damage occurs to the surface or some cells are left behind on the surface and then grow and contract. ERM can occur from a retinal tear, treatment for the retinal tear, retinal detachment, inflammation in the eye and many other reasons but these are less common. We see them most often in the retired population and so we can expect a tsunami of ERM over the next 20 years!

What can be done?

Surgery involves removing the jelly of the eye (Vitrectomy) and then peeling the scar tissue from the surface of the retina and I routinely take the layer under the scar tissue to ensure it is all off and is less likely to come back. Surgery is done under a local anaesthetic and is completely comfortable. If you wanted to have some 'chemical courage', sedation can be given to relax you.

I will routinely take the lens (cataract) as there is usually early cataract and Vitrectomy causes cataract. From a patient perspective having both done in one go will result in many fewer visits to the hospital, one less operation and getting the sight back more quickly. In younger patients cataract may take many years and we can discuss options for leaving the lens alone! Once the cataract is out the jelly is removed (Vitrectomy) by a tiny guillotine which cuts the jelly into tiny pieces 5000 times a minute and then sucks it away. A salt water drip keeps the eye inflated during this removal. With the jelly out the surface layer of the eye is peeled. The fluid you produce then fills the eye, you no longer need your jelly.

Should I have it done?

Nobody jumps out of a second floor window, If a Lion walked into the room most would jump! If you choose not to have surgery the vision is very likely to get worse and very unlikely to get better. It may be the vision is slightly down but the distortion is severe and this is a good reason to have surgery. I will discuss all these factors with you and you can decide if it is a lion or a pussy cat! I will not force you to have surgery, much as I enjoy doing it!
In terms of improvement in vision it can take 3 months to get back the vision you started with. Think of peeling a scab off your hand, the skin becomes sore underneath. In a similar way the retina sometimes swells after surgery and takes time to settle.The main risk that I would consider significant as a patient is the risk of retinal detachment at around 3%. A careful check is made at the end of the operation and any holes in the retina at the edge that can result in retinal detachment are treated and a gas might be put into the eye. I leave air in the eye and so you will not see on day 1 but over the week the bubble of air gets smaller rounder and lower and then goes. At no point should another shadow appear, if it does we will see you urgently as this might be the retina coming off. Sometimes people are left with some swelling at the back of the eye which results in blurred vision and this may require further treatment and sometimes this swelling remains despite treatment.
The good news is vision continue to improve over one year and an average gain of 2-3 lines can be expected. If we at least stop the vision getting worse that is a success.