Macular Edema & Membrane

Macular Edema & Membranes

Macular syndromes affect the macula, a small one to two millimeter area located in the center of the retina. This is where the highest concentration of visual cells is found, explaining why the macula controls the sharp, clear, central vision necessary for reading, writing, or driving.

The rest of the retina is responsible for the less precise vision of the peripheral field. In all macular syndromes, no matter what the cause—retinal vein occlusion, inflammatory disease, post-surgical disease, uncontrolled diabetes, abnormal attachment of the vitreous to the retina, or a spontaneous epiretinal membrane of unknown origin—an edema has been formed in the macula. This edema will then extend and disrupt the nervous cell connections, and thus a good amount of visual input will not be sent to the brain. A continued, progressive loss of central visual acuity will follow. The bigger the edema, the more vision that will be lost. In addition, if there are retinal folds cause by the attachment of the vitreous, the patient will experience deformed vision. Little by little, the unconnected cells will irreversibly die, and without any intervention, the patient is falling down the stairs of visual health, without hope of returning to the top.

Surgical Treatment

The goal of the operation is to stop the vision loss or even potentially obtain a slight improvement. In the majority of cases, the surgeon will likely proceed in the following manner. First, he will do a vitrectomy, that is the removal of the vitreous body with the help of a vitreotome, replacing it with an appropriate liquid. He will then remove the posterior hyaloïd, the envelope of the vitreous body, often stuck to the retina.
Then, he will remove the internal limiting membrane of the retina from the posterior region. This membrane is a very thin film a few microns thick, or, in other words, ten times thinner than a piece of hair. Not only will doing this help fight the edema and block the process of cellular destruction, and thus vision loss, but it will also allow some of the remaining nerve cells to reconnect, and explaining why it is sometimes possible to recuperate a portion of the lost vision.

As soon you leave the clinic, you will place eye drops in your eye. The name of the eyedrop, the frequency of use, and the duration of the treatment will all be stipulated by your original prescription.

You will be able to take off the eye patch the day after the operation. You will be able to participate in normal activities, but you will need to respect certain precautions for an additional 15 days:
- First, do not irritate your eye; be careful when you use shampoo and soap and do not use swimming pools.
- Second, avoid all sources of infection. Avoid catching a cold and avoid infected people. An ocular infection is a very serious complication that necessitates emergency treatment. If your eye is experiences redness or pain call your surgeon immediately.

You vision will progressively improve in the six months following the operation. If everything goes well, in one month’s time, your vision will more or less return to the level experienced before surgery and this should not lower. Visual improvement, if it occurs, will take place over the following six months. Therefore, do not plan on changing your glasses in the first six months.

Finally, know that the risk of developing a retinal detachment in the months or years to come is slightly elevated. In addition, patients who have not undergone cataract surgery can experience an acceleration of the physiological development of the cataract.

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