Macular Pucker

I. What is Macular Pucker?
Macular pucker is literally a puckering or wrinkling of the central vision area, known as the maculae. If the puckering is minimal, it is called surface wrinkling. If the puckering is moderate, the macula can appear as crinkled cellophane. This is called cellophane maculopathy. If the wrinkling is more severe, then the condition is then a full macular pucker.

Macular Pucker (fluorescein angiogram) Click to Enlarge

Macular Pucker (fundus photo - same patient) Click to Enlarge

II. What is the mechanism that causes Macular Pucker?
Thin transparent scar tissue forms on the surface of the retinal tissue and tends to contract. This contracting tissue causes puckering of the retina. The symptoms of macular pucker are distortion and decrease in central vision. These symptoms may be minimal, moderate or severe.

III. What causes the development of this scar tissue?
Most commonly, the situation is spontaneous, and certainly there is no inherent cause on the part of the patient. Sometimes the scar tissue is noted to develop after injury or damage to the eye as well as after eye surgery.

IV. What are the consequences of Macular Pucker?
Most patients with macular pucker have minimal to moderate distortion of vision. Many patients with minimal surface wrinkling do not even notice they have a problem, particularly if it does not affect the absolute dead center vision area. If the situation results in significant puckering and wrinkling of the macula, the vision is markedly distorted and tends to remain poor unless surgery is utilized to rectify the problem.

V. Does Macular Pucker always lead to these consequences?
Occasionally patients can have spontaneous peeling of the scar tissue from the surface of the retina. This is a rare event. Most often, the situation remains stable at the level noted when first evaluated by the physician. A small percentage of patients tend to get worse over time.

VI. What is the treatment for Macular Pucker?
Surgery is the only method to treat this problem. Surgery involves peeling the scar tissue from the surface of the retina.

VII. What does the surgery entail?
The surgery for epiretinal membrane removal requires the patient to be hospitalized. The surgery is generally out-patient and can be done under local or general anesthesia. Small instruments are placed into the eye and the membrane is peeled off the surface of the retina, allowing the retina to become "unpuckered." Hopefully, when the retina loses its pucker the vision will then be restored to a more normal level.

VIII. Are there alternatives to surgical therapy?
The only way to resolve this problem of macular pucker is with surgical treatment. Obviously, bright reading lights, magnifiers, and other optical aids would be useful if surgery is not indicated, or is not desired by the patient. However, peeling the membrane from the surface of the retina, thereby allowing the retina to flatten out is the most promising and successful method to improve the patients vision.

Retinal Disorders

Diabetic Retinopathy
Age-Related Macular Degeneration
Retinal Vein and Artery Occlusions
Macular Hole
Macular Pucker
Retinal Tears and Detachments
What is Fluorescein Angiography?
What is Photodynamic Therapy?
What is ICG Angiography?
What is optical coherence tomography?

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