Macular Pucker
What is Macular Pucker?
You have developed a condition known as macular pucker. This problem is also known as epiretinal membrane, cellophane maculopathy, or surface wrinkling retinopathy.
How is Macular Pucker Caused?
The exact cause is unknown. It is characterized by an abnormal, thin, cellophane-like piece of tissue that grows on the surface of the center of the retina. (The center of the retina is where the image that you see is focused and is also called the macula.) The tissue grows as a sheet or membrane on the retinal surface and, in some people, contracts and distorts the center of the retina. The effect is some degree of distortion or blurring of the central, focused vision. The peripheral vision is usually not affected at all. Although there may occasionally be other symptoms such as floaters, it is the distortion and blurring which is most troublesome.
What is the Treatment for Macular Pucker?
Surgery is the only known treatment option for this problem. In situations where the pucker is very mild and the visual acuity good, observation is usually recommended. However, for more significant pucker that causes visual distortion or blur, surgery may help. The surgery is called a vitrectomy and consists of removing some of the vitreous gel and the epiretinal membrane which is wrinkling the retina. The surgery generally takes less than one hour, can be performed under local or general anesthesia, and is usually a same day surgical procedure (in and out the same day). Usually the eye is minimally irritated afterwards, and patients resume normal activity within a few days.
What is the Benefit of Surgery for Macular Pucker?
Most patients benefit by having some degree of improved visual acuity or decreased distortion. The exact amount of improvement is difficult to predict and not all patients improve even though the retina may successfully unwrinkle after the surgery. In general, those with a fairly “fresh” pucker will have more significant visual improvement compared to those with a very long-standing pucker. Vision improvement is generally slow with a gradual reduction in distortion symptoms over weeks to months. It is rare for the epiretinal tissue to grow back.
Surgery for a macular pucker is elective, and as with any surgical procedure, there are risks from the operation and whatever anesthesia is used. Fortunately, complications are rare, but should an ocular complication such as retinal detachment, hemorrhage, or infection develop, there can be some degree of visual loss. It is relatively common to have cataract development or progression months after surgery. Patients who elect to have surgery for a macular pucker should be aware that cataract surgery may be indicated at some point in the future.
In general, the other eye is not similarly affected, although occasionally both eyes will develop macular pucker. Surgery on the first eye has no affect on the possible development of a similar problem in the other eye.
