Macular Pucker

What is a macular pucker?

A macular pucker is an extra layer of tissue that has formed on the eye's macula. The macula is located in the center of the retina, an area of light-sensitive cells at the back of the eye. The macula is responsible for central vision, which is the sharp, straight-ahead vision we need for reading, driving, and seeing fine detail.

A macular pucker can cause blurred and distorted central vision. It is usually related to aging, and happens in people over age 50. Macular pucker is also called epiretinal membrane, preretinal membrane, cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, and premacular fibrosis.

What causes a macular pucker?

Most of the inside of the eye is filled with vitreous, a gel-like substance that helps the eye maintain a round shape. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is called vitreous detachment. It is normal and does not cause symptoms. Some people might have a small increase in floaters, which are little "cobwebs" or specks that seem to float about in the field of vision, but this is usually not harmful.

But sometimes the vitreous can damage the retina when it pulls away. (This is not the same as a macular hole.) When this happens, the retina begins a healing process to the damaged area and forms scar tissue, called an "epiretinal membrane." This scar tissue is firmly attached to the retina surface. When it shrinks, it causes the retina to wrinkle, or pucker. This usually does not harm central vision. However, if the scar tissue forms over the part of the retina that contains the macula, the sharp, central vision becomes blurred and distorted.

Most macular pucker is related to aging, but it can also be caused by other eye conditions. These include detached retina, inflammation of the eye (uveitis), and diabetic retinopathy. A macular pucker can be caused by trauma from eye surgery or eye injury as well.

What are the symptoms of a macular pucker?

The main symptom of macular pucker is changes in vision. Vision changes and loss can range from none to severe. But severe vision loss is uncommon.

People with a macular pucker might notice that their vision is blurry or slightly distorted, and straight lines can appear wavy. They might have difficulty seeing fine details and reading small print. They might also have a gray area in the center of vision, or even a blind spot.

Is a macular pucker the same as age-related macular degeneration?

No. Macular pucker and age-related macular degeneration are two separate conditions, but the symptoms can be similar. Both conditions are called "macular" because they involve the "macula" area of the retina. Talk to your eye doctor if you think you have one of these conditions.

Can macular pucker get worse?

For most people with macular pucker, vision can get worse over time, but this does not happen rapidly. Usually macular pucker affects one eye at first, but it might affect the other eye later.

Is a macular pucker similar to a macular hole?

A macular pucker and a macular hole are different conditions, but they both can occur as a result of the vitreous pulling away from the retina. When the pulling only causes small damage, the retina forms scar tissue to heal itself. This is a macular pucker. If the pulling causes serious damage, it can tear the retina in the macular area and create a hole. This is a macular hole. A macular pucker will not turn into a macular hole.

Both conditions can cause distorted and blurred vision, but a macular hole is more likely to cause permanent vision loss than a macular pucker. If you think you have either of these conditions, talk to your eye doctor.

How is a macular pucker treated?

A macular pucker usually does not need treatment. Vision problems are usually mild, and do not interfere with daily activities, such as reading and driving. In many cases, people can adjust to the changes in their vision. Treatments such as eyedrops, medications, and nutritional supplements will not help vision problems from macular pucker.

Sometimes, the scar tissue that causes the macular pucker separates from the retina, and the macular pucker clears up on its own.

In serious cases, people with macular pucker develop vision problems that are severe enough to interfere with their daily activities. These people might need surgery to treat their macular pucker. The surgery eye doctors use to treat a macular pucker is called vitrectomy with membrane peel.

During a vitrectomy, the vitreous gel is removed to prevent it from pulling on the retina. The doctor replaces the gel with a salt solution. Because the vitreous is mostly water, a person does not notice any difference between the salt solution and their normal vitreous. The doctor will then perform a "membrane peel" to remove the scar tissue that causes the puckering. A vitrectomy is usually performed under local anesthesia.

After your vitrectomy, you will need to wear an eye shield for a few days or weeks to protect your eye. You will also need to use medicated eye drops to protect your eye from infection and inflammation.

What are the benefits and risks of surgery?

In most cases, surgery for macular pucker can improve vision, but does not bring it back to normal. Most people are able to regain about half of the vision they lost from a macular pucker. Some people have much more vision restored, some less. In most cases, surgery can help with vision distortion. Vision recovery can continue for as long as three months after surgery.

The most common complication of a vitrectomy is an increase in how quickly cataracts develop. You might need surgery for cataracts within a year or two after the vitrectomy. Less common complications include retinal detachment either during or after surgery, and infection after surgery. Also, the macular pucker can grow back, but this is rare.

Talk to your eye doctor about whether surgery is a good option for you.

This information was adapted from information provided by the National Eye Institute to help patients and their families search for general information about macular pucker. An eye care professional who has examined the patient's eyes and is familiar with his or her medical history is the best person to answer specific questions.