There is apparently a way to remove this, but at this point no one wants to do it; I get the impression that it is a somewhat risky surgery, and that it is best to wait until my vision is considerably worse. What can you tell me about the condition, the surgery and the risks?

FYI, I had a kidney/pancreas transplant in 2005 that was successful and I have normal blood sugars now with no need for insulin.

• Answered by: Dr. Anne Berenbom

  December 22, 2009

  From the information you’ve provided, it sounds like you have what is called an epiretinal membrane, which is a very thin layer of scar tissue overlying the macula, or central area of the retina responsible for central vision. The membrane sits on the macula like a piece of cellophane, The membrane tugs on and distorts the macula, causing distortion and blurring of vision. No one knows exactly what causes epiretinal membranes and they are not necessarily related to diabetes. In fact, at autopsy, epiretinal membranes are found in 20% of patients over age 75. 

  The only way to get rid of an epiretinal membrane is by surgical removal.  A pars plana vitrectomy is performed, meaning the jelly (vitreous) overlying the retina is removed, and then the membrane is carefully peeled off of the macula.  Patients see an improvement in vision in 50-75% of cases, but very few patients return to normal vision.  Surgery is usually reserved for patients with vision of 20/60 or worse, but this can vary from surgeon to surgeon.  On the other hand, patients who do not undergo surgery usually remain stable and do not suffer from further worsening of vision.  Any eye surgery carries risks, including infection or bleeding.  This particular surgery carries a risk of creating a retinal hole or tear, which would require more extensive surgery to repair.  But the bottom line is that surgery is not a guaranteed fix and that vision is very likely to remain stable with no intervention. 

  It is wonderful that your sugars are now controlled and that you no longer require insulin.  However, that does not have any impact on your epiretinal membrane. It is difficult to give you exact answers to your questions without examining you myself.  My advice is to discuss this matter with your retina specialist and also to consider getting a second opinion.  At the very least, you will have the peace of mind that you have done everything you can to try to improve your vision.

  About the Expert:

  Anne E. Berenbom, M.D. is an ophthalmologist currently practicing in New York City. She received her undergraduate degree, B.A.(Biology), from the University of Pennsylvania, Philadelphia, PA and then earned her Medical Doctor Degree from Washington University in St. Louis. Continuing her education, Dr. Berenbom completed a Transitional Internship at University of Chicago, Weiss Memorial Hospital, Department of Internal Medicine. She then completed an Ophthalmology Residency Program from the New York Eye & Ear Infirmary, Department of Ophthalmology. Dr. Berenbom is currently an attending physician at the Eye Institute of New York. As a comprehensive ophthalmologist, Dr. Berenbom has extensive experience screening for and treating Diabetic Eye Disease.