What is Macular Pucker?
This condition is also referred to as epiretinal membrane, cellophane maculopathy, or surface wrinkling retinopathy. It is characterized by an abnormal, thin, cellophane-like piece of tissue that grows as a sheet on the surface of the center of the retina (macula). A macular pucker may develop in response to injury or swelling in the eye after a retinal tear or detachment, after cataract surgery, or in association with diseases such as uveitis or diabetes. However, in most cases there is no identifiable cause. Central vision may become blurred or distorted if the macular pucker contracts over time; peripheral vision is usually not affected.
What is the Treatment for Macular Pucker?
Surgery is the only known treatment option. If the macular pucker is mild and visual acuity is good, observation is usually recommended. However, if the pucker has caused significant visual distortion or blur, surgery may help. The surgery is called a vitrectomy and consists of removing some of the vitreous gel and peeling away the abnormal membrane on the surface of the retina that is causing the wrinkle or pucker. The surgery generally takes less than an hour and can be performed under local or general anesthesia as an outpatient procedure. 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 will gradually experience some degree of improved visual acuity or decreased distortion in the weeks to months following surgery. The exact amount of improvement is difficult to predict and not all patients improve even with successful removal of the macular pucker. In general, those with a fairly “fresh” pucker will experience greater visual improvement compared to those with a very old pucker. It is rare, though possible, for a macular pucker 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. Your surgeon will further outline the risks, benefits, and alternatives of surgery with you and make tailored recommendations based on the unique findings of your eye.