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Membrane Peeling


Vitrectomy with the membrane peel is most common vitreoretinal surgery. The method is generally performed to intervene in the event of the epiretinal membrane (ERM) formation or vitreomacular traction syndrome which presents with the visually significant symptoms.
An ERM is a fibrocellular, semitranslucent, avascular membrane located along with the inner surface of retina’s internal limiting membrane (ILM). In most instances, ERM formation is observed over or around macula. Clinically, you may document with loss of foveal reflex, parafoveal light reflection (that looks similar to the cellophane), wrinkling of retinal surface, localized intraretinal hemorrhages or the alteration of parafoveal vasculature. Macular edema and/or pseudoholes can also be related with the ERM development.
Some ERM patients were asymptomatic however, most of the affected patients report like distorted vision or scotomas which are repeatable on the Amsler grid testing. Because some of the ERMs slowly worsen over the time, patients generally experience gradual reduction in the visual acuity.
The first clinical symptom of the ERM formation will tends to be an unnatural macular appearance. Even though fluorescein angiography may be used to help in diagnose ERM, OCT has become a gold standard its high-resolution imaging of vitreoretinal interface which detects even subtlest membrane.
In vitrectomy with the membrane peel technique, the instruments were generally inserted 4mm behind limbus. The technique is done under local anesthesia with very tiny incision ports which do not require any suturing. Visual recovery differs from the patient to patient, but will be dramatic the very next day. 

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