Introduction

Definition of macular pucker

Macular pucker, also known as an epiretinal membrane, is when there is a wrinkle in the retina caused by scar tissue.

Importance of understanding the condition

Macular pucker does not always cause major issues with your vision, but it can distort it in some cases, which is why it is important to not ignore your eye health.

Pathophysiology of macular pucker

An epiretinal membrane is a thin layer of tissue that forms on the surface of the retina in the eye. This happens because of a condition called posterior vitreous detachment (PVD), which is common in the elderly. PVD occurs when the gel-like substance inside the eye (vitreous) shrinks, which then pulls away from the retina. When PVD happens, it can create small lesions in the inner layer of the retina, allowing cells to move to the surface and change into a type of cell that produces an epiretinal membrane. This membrane can cause the retina to wrinkle, leading to macular pucker.^2,3

Causes and risk factors^2,3,4

What are the causes of macular pucker?

• Trauma in the eye
• Infection
• Tears in the retina
• Retinal detachment 
• Eye inflammation
• Previous surgery in the eye
• Retina disease caused by diabetes

So, what are the risk factors?

• Age
• Separation of vitreous humour from the retina
• Laser eye surgery or any other kind of eye surgery
• Eye inflammation or uveitis
• Retinal tear or detachment

Symptoms¹

There are various symptoms that can cause macular pucker, including:

• Central vision distortion - straight lines may appear as wavy
• Blurred vision
• Difficulty in reading fine print
• Vision problems
• Double image

Diagnosis^1,3,4

Comprehensive Eye Exam

During your visit to the ophthalmologist, your eye care professional will go through a thorough medical history and ask you about your symptoms and also carry out an eye exam, where they will dilute your eyes to make them more open, so ensure they can see the retina. Next, if they find anything abnormal, tests will be carried out using a light and a magnifier tool to look your eyes closely. Other tests include:

• Optical Coherence Tomography (OCT) - takes images of the retina
• Fluorescein Angiography
• Amsler grid test - examines the distorted vision with the use of pages containing small squares produced by vertical and horizontal lines

Treatment options^1,4,5

Non-surgical treatments

Some of the non-invasive treatments include:

• Magnifying tools
• Prescription glasses - improve the overall vision but does not treat macular pucker
• Using reading lamps

Surgical treatments

There are also 2 types of surgical treatments that are available, including:

Vitrectomy

Procedure description

Your doctor will make small incisions in the white of the eye, to help small instruments to go inside of the eye. A vitreous gel inside of the eye is replaced with a salty fluid. Then, fine forceps are used to peel a membrane from the eye’s retina. When it is finished, the lining of the retina is examined to treat any other condition that could happen, such as retinal detachment.

• Post-Operative Care
• Regular check-ups
• Eye drops to prevent infections
• Do not touch your eye
• Avoid getting shampoo and soap for about a month

Membrane peeling

Procedure Description

Your doctor will carefully remove the membrane from the retina.

Potential complications¹

Your doctor will make sure you do not have any discomfort and ensure to take precautions, but there is always some risk and or complication during surgery, including:

• Bleeding
• Retinal detachment or tear
• Infection
• Worsening of cataracts
• Macular hole
• High eye pressure or glaucoma

Prognosis and long-term outlook 

In most cases of macular pucker, it does not need to be treated. You will need to have regular eye exams with your doctor to monitor your vision and your overall eye health.¹ 

Summary

Macular pucker at first may sound scary because it affects your vision, however, you do not need to worry because your doctor and their team will do their best to ensure you are okay. In fact, most cases do not even need treatment, but the best approach is to have regular eye examinations to ensure it is well monitored.