Macular Pucker

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"Puckering" of the macula occurs when a thin film of scar tissue forms over the surface of the retina.

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An optical coherence tomography scan shows the thin film of scar tissue on the upper surface of the retina (white arrows).

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Macular puckers are treated, when necessary, by microsurgery to carefully peel away the scar tissue inside the eye.

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Pictured here is a macular pucker before surgery, showing distortion and wrinkling of the retina.

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After recovery from macular pucker surgery, the scar tissue is gone and there is less wrinkling of the retina.

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What is a Macular Pucker?

The macula is the centermost portion of the retina, located directly in the back of your eye. It is responsible for sharp, detailed vision. Normally, the macula lies flat, like film lining the back of a camera. Sometimes a thin scar tissue forms over the macula, causing it to become wrinkled or “puckered.” Macular pucker is sometimes also called “cellophane maculopathy” or an “epiretinal membrane.”

What Causes a Macular Pucker?

A thin, transparent sheet of scar-like tissue migrates across the surface of the macula, where it clings onto the delicate tissues. Eventually, it begins to shrink and create wrinkling of the macula. Eye conditions that may be associated with the development of a macular pucker include:

  • Posterior vitreous detachment (aging of the gel inside eye)
  • Torn or detached retina
  • Inflammation inside eye
  • Severe injury to eye
  • Retinal blood vessel disorders
A macular pucker is not usually related to any medical problem outside the eye.

Is a Macular Pucker the Same as Age-Related Macular Degeneration?

No. A macular pucker and age-related macular degeneration are two separate and distinct conditions, although the symptoms for each are similar. An eye care professional examining your eye will know the difference. Sometimes both conditions can exist in the same eye, but they are still separate problems.

What are the Symptoms of a Macular Pucker?

A patient with a sufficiently severe macular pucker has blurred and distorted vision, just as one would expect a picture to appear from a camera with wrinkled film. Straight lines, like doorways or telephone poles, can appear wavy. Vision loss can vary from barely noticeable to severe. One or both eyes may be involved. For most people, vision remains relatively stable and does not get rapidly worse.

How is it Detected?

Your ophthalmologist can detect a macular pucker by examining your retina. Various photographic tests are used to determine the extent of damage to the macula.

How is a Macular Pucker Treated?

Surgery is not necessary for everyone who has a macular pucker. Eye drops, medicines, and lasers have no effect on this condition. For people who have only mildly blurred vision and are not bothered by it, no treatment is necessary. However, for those whose vision is more significantly affected, vitrectomy surgery is the only treatment that can remove a macular pucker. During this outpatient procedure, your doctor uses tiny instruments to remove the scar-tissue that is wrinkling the macula.

Usually, the macula flattens out. The symptoms slowly improve, although the vision does not always return to normal. Typically, patients can expect two or more lines of improvement on the eye chart, however cataracts (clouding of the natural lens in the eye) may develop or progress more rapidly after surgery to fix the macular pucker. Cataract surgery may be necessary to obtain the best vision after macular pucker surgery.