Epiretinal gliosis (macular pucker)

Distorted or blurred vision may indicate a condition called epiretinal gliosis. In this disease, a membrane forms on the retinal surface, which can cause the retina to unfold. This can result in significant visual disturbances.

Epiretinal gliosis occurs predominantly in patients over the age of 60. Treatment with medication has not been possible up to now. In the course of surgery, however, we can usually improve vision significantly.

Epiretinal gliosis surgery is performed on an inpatient basis by means of pars plana vitrectomy (removal of the vitreous body). In this procedure, we remove the gel-like vitreous and the membrane on the retina. Removal of the membrane relaxes the center of the retina, and visual acuity improves again.

What is epiretinal gliosis?

Epiretinal gliosis is a retinal disease that most often occurs in the area called the macula, the area of sharpest vision in the back of the eye. The disease is also called macular pucker.

In epiretinal gliosis, cells are deposited on the retina, which over time can form a membrane and exert traction on the retinal surface. The retina then becomes distorted and wrinkles form. 

Often, epiretinal gliosis occurs at an advanced age without any apparent cause. However, it can also be caused by disease or surgery. An epiretinal membrane usually progresses slowly. Spontaneous healing is extremely rare. Whether surgery is necessary depends on how great the limitations or discomfort are for the patient.

Epiretinal gliosis: symptoms and complications

Epiretinal gliosis is usually first noticed when the patient complains of significant visual impairment. Typical of epiretinal gliosis is, above all, distorted perception in the central field of vision. Many patients see waves, crooked lines or even double images. 

Before surgery can be considered, further investigations are necessary. The above-mentioned symptoms can also occur in this or a similar form in other diseases, for example in age-related macular degeneration. Therefore, first of all a detailed examination of the affected eye as well as the partner eye takes place. With modern diagnostic methods such as optical coherence tomography (OCT), the retina can be examined without contact and possible changes can be precisely recorded.

What are the treatment options?

Epiretinal gliosis can only be treated surgically in the course of epiretinal gliosis surgery. Treatment with medication is not possible. Nevertheless, we do not always advise surgery immediately. Like any operation on the eye, the procedure involves certain risks, so that treatment is usually only performed when the patient finds the visual restrictions very disturbing. This is the case, for example, if the reading ability is severely impaired or the vision is severely distorted. The subjective symptoms are the main factor in deciding on the therapy.

During the operation, the surgeon inserts fine instruments into the eye and first removes the entire vitreous body. Then, using fine forceps under very high magnification through the microscope, the membrane is peeled off the retinal surface.

The incisions are so fine that they subsequently heal on their own and do not require suturing. The vitreous is replaced with a liquid or air.

What is the procedure for epiretinal gliosis surgery?

Comprehensive preliminary examinations take place before an operation. The decision for or against an operation is always made by the treating ophthalmologist in close consultation with you. The expected benefits of surgery must be carefully weighed against the possible risks. 

Epiretinal gliosis surgery takes about 30-60 minutes and is usually performed under local anesthesia in twilight sleep. The surgeon injects the anesthetic next to or behind the eyeball. This temporarily eliminates the sensation of pain, and you will not be able to move the eye on your own. This gives the surgeon the ability to perform the surgery with absolute precision.

The surgeon inserts the necessary instruments into the eyeball through three tiny access points. Using a suction-cutting device, he removes the vitreous body. After the operation, the removed vitreous body is replaced by the eye itself and the body's own fluid.

The entire operation is performed under a special surgical microscope, through which the surgeon can precisely control all the steps. 

After the maculapucker surgery, the eye is covered with a bandage and you are allowed to rest in our modern facilities. As a rule, patients stay with us at the clinic for a few days as inpatients. In this way, we can guarantee you comprehensive care after your surgery and are always there for you if you have any problems.

What should I do after the operation?

After the surgery, you should get plenty of rest, avoid rubbing your eyes, and avoid abrupt movements of your head. 

Immediately after epiretinal gliosis surgery, you may initially experience a significant deterioration in vision, for example, due to air filling the eye. This is quite normal and not a cause for concern. It is important to understand that it may take several months to reach maximum visual acuity.

Also, you should not drive yourself until your ophthalmologist deems your visual acuity to be adequate.

You should take a break from sports and physical activities for at least 1 - 2 weeks after the operation. Afterwards, we recommend that you slowly increase your activity without overstraining yourself. You should also temporarily refrain from visiting the sauna and swimming pool.

If there are other rules of conduct to be observed in your case, such as special positioning, your doctor will inform you about this before the procedure or after the operation. You will also receive detailed instructions on medication in the weeks following epiretinal gliosis surgery.

Are there any risks associated with macular pucker surgery?

Epiretinal gliosis surgery is nowadays a routine procedure that is performed regularly in our eye clinic. Nevertheless, every operation is accompanied by certain risks. This is also true for any treatment on the eye.

In addition to the general surgical risks (e.g. post-operative bleeding or infection), there is always a residual risk of injury to the retina or other eye structures. Furthermore, retinal detachment, cataract (cataract) or fluctuations in intraocular pressure can occur after surgery. Accordingly, it is important to carefully weigh the benefits and risks with you before deciding to undergo surgery.

Most complications can be successfully corrected with medication or a short follow-up surgery. Only very rarely are the consequences so severe that vision is irreversibly impaired. In this case, it is particularly important to choose the right doctor and clinic. You should also contact us immediately after the operation if you notice a sudden deterioration in vision or other unexpected complaints occur.

We are available for you 24 hours a day in our clinic in case of emergency.

What is the prognosis after epiretinal gliosis surgery?

Surgery can usually significantly improve vision. On average, about half of the lost visual acuity can be restored. The earlier surgery is performed, the greater the success of the treatment, as a rule. Nevertheless, due to the risks of surgery, it is not always advisable to operate as quickly as possible.

Our ophthalmologists are happy to take the time to advise you in detail. Based on your symptoms and your individual medical history, we will then decide together with you whether and when surgery should take place.