Conditions Treated · Macular Conditions

Epiretinal Membrane (Macular Pucker)

Written by Mr Robert Henderson BSc MBBS MD FRCOphth · Consultant Vitreoretinal Surgeon, Moorfields Eye Hospital & GOSH

What is an Epiretinal Membrane?

The macula is a small but critically important area at the centre of the retina. It allows us to read, recognise faces, drive, and perform any task requiring fine visual detail. An epiretinal membrane (ERM) — also known as a macular pucker, cellophane maculopathy, or premacular fibrosis — is a thin, translucent film of fibrous tissue that forms on the inner surface of the macula.

As the membrane matures, it can contract and cause the underlying retina to wrinkle, thicken, and distort. This interferes with the precise focusing required for sharp central vision, producing symptoms that range from mild blurring to significant visual distortion.

Epiretinal membranes are more common than many people realise, affecting approximately 2% of people over 50 and up to 12% of those over 70. In most cases they are idiopathic — arising spontaneously without an identifiable cause — though they can also develop following retinal detachment, retinal vein occlusion, diabetic eye disease, or intraocular inflammation.

Symptoms of Epiretinal Membrane

Symptoms are often gradual in onset and may initially be quite subtle. Many patients first notice the distortion when covering one eye. It is important not to dismiss these symptoms — early assessment allows accurate diagnosis and monitoring, and timely surgery when indicated can significantly improve outcomes.

Diagnosis

Epiretinal membrane is diagnosed through a combination of clinical examination and retinal imaging. At your consultation I will perform a detailed assessment including:

• Slit-lamp biomicroscopy — direct examination of the retinal surface
• Optical coherence tomography (OCT) — a non-invasive cross-sectional scan of the retina that reveals the membrane’s thickness, the degree of retinal distortion, and whether the macula architecture is preserved
• Visual acuity and Amsler grid testing — to quantify vision and map any distortion

OCT has transformed our ability to characterise epiretinal membranes accurately and to time surgery appropriately. It also provides an invaluable baseline against which postoperative improvement can be measured.

When is Surgery Recommended?

Not all epiretinal membranes require surgery. In cases where the membrane is thin, stable, and symptoms are minimal, careful observation with repeat OCT scanning is entirely appropriate. Many membranes remain stable for years.

Surgery is recommended when:

• Visual acuity has deteriorated to a level that affects daily activities
• Distortion is causing significant difficulty with reading or other tasks
• OCT demonstrates progressive retinal thickening or distortion
• The patient finds symptoms unacceptable and wishes to pursue surgical treatment

The decision to operate is always made jointly, taking into account your symptoms, your visual demands, your general health, and the OCT findings. There is no benefit to waiting until vision is severely reduced — earlier surgery, when the retinal architecture is better preserved, generally yields better visual outcomes.

Epiretinal Membrane Peel Surgery

The Operation

Surgical treatment for epiretinal membrane is called vitrectomy with membrane peel. It is performed as a day case procedure under local anaesthesia with sedation (or general anaesthesia if preferred) and typically takes 45 to 60 minutes.

Through three microscopic incisions in the white of the eye, I remove the vitreous gel and then carefully peel the epiretinal membrane from the retinal surface using fine forceps. In most cases, I also peel the internal limiting membrane (ILM) — a thin layer beneath the ERM — as this reduces the risk of recurrence and often improves the final visual outcome.

No gas bubble or posturing is required following straightforward epiretinal membrane surgery, which makes the recovery considerably more comfortable than some other retinal procedures.

After Surgery

You will go home the same day with antibiotic and anti-inflammatory eye drops to use for several weeks. Vision is typically blurred for the first few days to weeks as the eye settles. Most patients notice gradual improvement in clarity and a reduction in distortion over the following three to six months, though improvement can continue for up to a year.

It is important to have realistic expectations — while surgery reliably halts progression and improves vision in the majority of cases, complete resolution of all distortion is not always achievable, particularly when the membrane has been present for a long time. However, most patients are very pleased with the outcome and find their quality of life significantly improved.

Visual Outcomes

The results of epiretinal membrane surgery are generally very good. Studies show that:

• Approximately 80–90% of patients experience improved visual acuity following surgery
• Distortion improves in the majority of cases, though complete resolution is less predictable
• Recurrence of the membrane occurs in fewer than 5% of cases when ILM peeling is performed
• The greatest improvements are seen in patients who undergo surgery before vision has deteriorated significantly

Risks of Surgery

Epiretinal membrane peel is a well-established procedure with a favourable safety profile. As with all intraocular surgery, risks include:

• Cataract — the most common complication in patients who still have their natural lens; this typically develops within one to two years and is readily treatable
• Retinal tear or detachment — uncommon but requires prompt treatment if it occurs
• Infection (endophthalmitis) — rare but serious; antibiotic drops are prescribed to minimise this risk
• Temporary worsening of vision — occasionally vision is initially worse before improving
• Incomplete resolution of distortion — some residual distortion may persist

These risks will be discussed in full at your consultation. For patients with significant symptoms, the benefits of surgery considerably outweigh these risks.

Private Epiretinal Membrane Surgery in London

I perform epiretinal membrane peel surgery privately at 1 Welbeck, Marylebone, London (opening September 2026). Consultations and pre-operative assessments are available now. As a Consultant at Moorfields Eye Hospital — the UK’s leading specialist eye hospital — I bring the same surgical standards and expertise to private practice.

If you have been diagnosed with an epiretinal membrane, or if you are experiencing the symptoms described above, I would be happy to see you for an assessment. Early evaluation ensures that if surgery becomes necessary, it can be offered at the optimal time.

Mr Robert Henderson BSc MBBS MD FRCOphth is a Consultant Vitreoretinal Surgeon at Moorfields Eye Hospital and Great Ormond Street Hospital, and Clinical Lead for Ophthalmology at GOSH