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Macular Pucker

What is a macular pucker?

A macular pucker occurs when scar tissue forms over the center of the retina; the neurosensory tissue of the eye that transmits the optical images we see into the electrical images our brain understands.

The center of the retina is called the macula. The macula provides the sharp, most light-sensitive central vision we need for things like reading and driving. A pucker can cause distortion or blurring of central vision.

A macular pucker is also known as an epiretinal membrane, surface wrinkling retinopathy, and cellophane retinopathy.

What causes a macular pucker?

About 80% of the eye is filled with vitreous humor. The vitreous humor is made up mostly of water, yet it has a firm jelly-like consistency. The vitreous helps to hold the spherical shape of the eye and helps to keep the retina in place. As we age, the vitreous starts to liquify and partially detach from the retina causing a partial posterior vitreous detachment or a complete posterior vitreous detachment. The proteins and collagens in the vitreous also start to thin over time. This is normal and rarely effects vision other than causing small shadows or floaters.

Sometimes, the vitreous detachment can cause microscopic changes in the integrity of the retina. The retina than tries to heal itself by forming a small epiretinal membrane or scar tissue over this area. When the scar tissue contracts it can cause the surface of the retina to wrinkle or pucker causing central vision distortion which may be mild or may begin to affect your daily activities.

What can I expect during a visit to evaluate a macular pucker?

After a comprehensive, dilated eye examination is performed by your ophthalmologist, a series of diagnostic tests may be ordered to better evaluate the health of your retina. These tests include, but are not limited to:

  • Fundus Photography
  • Optical Coherence Tomography (OCT)
  • Optical Coherence Tomography Angiography (OCT-A)
  • Intravenous Fluorescein Angiography (IVFA)

Along with a comprehensive eye examination, diagnostic testing directly correlates in the assistance of each patient’s individual plan of care. Once diagnostic tests are performed, your physician can better map your retinal needs in order to best preserve your vision.

How is macular pucker treated?

Most often a macular pucker does not need treatment. Sometimes, vision distortion is mild enough that it does not interfere with daily activities. The scar tissue may even separate from the retina on its own, healing itself. If the distortion does begin to affect daily activities, your physician may suggest a surgical procedure called vitrectomy with membrane peel. This surgery is an outpatient procedure and is done under general anesthesia. The surgical physician will remove the vitreous humor and replace it with a salt solution with a balance much like the vitreous itself. A membrane peel is then performed to remove the scar tissue that was causing the pucker. After surgery, eye drops will be prescribed to help aid the healing process as well as prevent infection. A follow up appointment will be scheduled with the surgical physician within a week to evaluate the outcome of the procedure. Daily activities can usually be resumed in a few days.