Epiretinal Gliosis - Membrane Formation, Symptoms, and Retinal Surgery

Epiretinal gliosis is a retinal disease that primarily affects people aged 50 and older. A typical characteristic is the accumulation of cells on the surface of the retina, usually in the macula—the area responsible for the sharpest vision. 

Experts therefore also refer to epiretinal gliosis as a macular pucker. If the membrane contracts, it causes the retina to fold, and visual acuity decreases. Distorted vision is also typical of epiretinal gliosis. 

The condition usually develops very slowly and without any apparent cause (primary gliosis). However, it can also occur as a result of other diseases or following surgical procedures (secondary gliosis).

If epiretinal gliosis is suspected, the ophthalmologist is always the first point of contact. If surgery is necessary, the ophthalmologist refers the patient to an eye clinic or the appropriate specialty department.

The ophthalmologists working here may also be specialists in epiretinal gliosis. After completing their medical studies, they underwent five years of further training to become board-certified ophthalmologists. They then completed a two-year practical training period. 

During this practical phase, they learn the standard surgical techniques, including those used in the treatment of epiretinal gliosis.

An Overview of Treatment Options

Even when diagnosing epiretinal gliosis, the ophthalmologist relies on state-of-the-art procedures.

Optical coherence tomography (OCT) examines the retina in detail and visualizes its various layers without touching the eye.

Optical coherence tomography allows for a detailed examination of the retina and its structures @ Med Photo Studio /AdobeStock

There is no medication available to treat epiretinal gliosis. Surgery is the only effective treatment. The timing of the procedure depends on the individual course of the disease. 

If vision is only mildly impaired, the specialist usually schedules frequent follow-up visits to monitor the progression of the gliosis. If vision is severely impaired, surgery is performed promptly. A microsurgical technique such as sutureless pars plana vitrectomy is used. During this procedure, doctors completely remove the cell membrane located on the retina. Experts have continued to refine the technique in recent years, so it is considered very safe. 

In most cases, vision improves significantly. However, it takes several months for the brain to learn to interpret the new images correctly. 

You will therefore need to be patient after the surgery. It is also advisable to attend follow-up appointments at regular intervals, as pars plana vitrectomy increases the risk of cataracts.

Conclusion

Epiretinal gliosis is a retinal disorder in which a membrane forms on the surface of the retina and can lead to visual disturbances such as blurred vision and distorted vision. This form of retinal disease, also known as macular pucker, primarily affects the macula—the center of the retina, which is crucial for sharp vision. Epiretinal gliosis frequently occurs in the posterior segment of the eye and can develop in various stages, although the course of the disease varies greatly from person to person.

Typical symptoms of epiretinal gliosis include metamorphopsia—that is, distorted vision—as well as other visual disturbances that impair vision. Early diagnosis is made through an ophthalmological examination and modern imaging techniques such as optical coherence tomography (OCT) or SD-OCT, supplemented by tests such as the Amsler grid. At an eye clinic or specialized eye center, diagnosis and treatment are tailored to the individual, although not every case of epiretinal gliosis requires immediate treatment. 

In early-stage cases, spontaneous healing is possible, while advanced forms may require surgical treatment. During a pars plana vitrectomy performed under anesthesia, the epiretinal membrane is removed through a procedure known as peeling to relieve pressure on the underlying retina.

Such changes cannot be adequately treated with medication alone, which is why surgical procedures are among the most important treatment options.

The prognosis depends heavily on the course of the disease and the timing of treatment, with early diagnosis being crucial. Overall, it is evident that epiretinal gliosis can be closely associated with other retinal diseases such as macular degeneration or retinal detachments, and therefore regular ophthalmological checkups are essential.