Managing epiretinal problems challenging

MAUI, Hawaii — Diagnosing and managing epiretinal membranes and macular holes can be difficult, according to one surgeon speaking here at Hawaii 2003: the Royal Hawaiian Eye Meeting.

“Epiretinal membrane problems are common in about 15% of patients and about 70% have some form of epiretinal problems,” said Carmen A. Puliafito, MD, MBA. “I suspect that these problems are associated with postoperative cystoid macular edema.”

He added epiretinal membranes are mostly associated with “relatively good vision and are not progressive; they’re stable over long periods of time. Some may require vitreous surgery and some are associated with macular edema.”

Dr. Puliafito acknowledged that there are “sleeper” cases out there that are extremely difficult to manage and diagnose.

When it comes to fixing macular holes, “you need to tell your patients the facts,” Dr. Puliafito said. This includes the 100% cataract incidence post-vitrectomy, he added.

“Macular holes can be a very, very confusing syndrome,” he said. After a patient has had a macular hole for 2 or 3 years, surgery may be able to close the hole, but the patient’s vision will not improve, he said.

“Early stage macular holes are the ones we like to operate on,” Dr. Puliafito said. “You really want to operate on them when they’re 20/50 or 20/70.”