Managing coexisting epiretinal membranes and cataracts: A combined surgical approach for optimal vision restoration

Epiretinal membranes and cataracts are two common eye conditions that can significantly impact vision. When these conditions coexist, addressing them together through a combined surgical approach can provide the most effective treatment and improve visual outcomes.

Mr Jignesh Patel, distinguished consultant ophthalmologist, explains why these conditions often occur together, the benefits of a combined surgical approach, and the expected recovery of the procedure.

Why are epiretinal membranes and cataracts often treated together?

Epiretinal membranes and cataracts frequently coexist, particularly in older adults, as both conditions are linked to age-related changes in the eye.

In some cases, the presence of an epiretinal membrane can also accelerate cataract development, especially if inflammation or previous retinal surgery is involved. Furthermore, patients who have undergone vitrectomy for epiretinal membranes often experience accelerated cataract progression.

In these clinical scenarios, addressing one condition without managing the other can lead to less-than-ideal vision restoration. Simultaneous treatment of both conditions ensures better visual outcomes and reduces the need for multiple surgeries.

What is a combined surgical approach for epiretinal membranes and cataracts?

A combined surgical approach involves performing cataract surgery and vitrectomy in a single operative session, typically under local anaesthesia. To reduce the risk of infection, the eye is prepared in a sterile environment before the procedure.

Your ophthalmologist will begin with the vitrectomy, creating tiny incisions to insert surgical instruments into the eye. The vitreous gel will then be removed to access the retinal surface. Using delicate tools, along with high-magnification imaging, your ophthalmologist will carefully peel away the epiretinal membrane.

After the epiretinal membrane has been addressed, your ophthalmologist will proceed with cataract removal. The cloudy natural lens will be broken apart using ultrasound (phacoemulsification) and then extracted. Your ophthalmologist will implant an artificial intraocular lens (IOL) in its place to restore the eye’s focusing ability.

Once both procedures are completed, your ophthalmologist will close the incisions or allow them to self-seal, depending on their size. Antibiotic and anti-inflammatory eye drops will be prescribed to aid recovery.

Are there specific considerations for IOL selection?

Yes, IOL selection is crucial for patients undergoing combined surgery for epiretinal membranes and cataracts. The choice should be based on a thorough evaluation of the patient’s retinal and ocular health, the extent of macular involvement, and the anticipated visual outcomes.

Monofocal IOLs or extended-depth-of-focus lenses are typically preferred. However, toric IOLs may be considered for patients with astigmatism. Premium IOLs should be used with caution, as macular health may affect postoperative visual results.

What is the expected recovery time after surgery?

Recovery from combined surgery typically takes a few weeks. Most patients will notice an improvement in their vision within a few days to a week, but full visual recovery may take up to 3 months as the eye heals and the brain adapts to the changes in visual input. Proper postoperative care, including attending follow-up appointments, is essential for optimal healing.

It’s important to have realistic expectations about the degree of improvement. Cataract removal can restore clarity and peeling the epiretinal membrane can reduce distortions. However, vision may not return to perfect levels, especially if there was pre-existing macular damage. The final outcome will depend on factors such as the severity of the epiretinal membrane, the presence of other retinal conditions, and the overall health of the eye.

To book an appointment with Mr Patel, contact the clinic today.