A macular pucker (also called an epiretinal membrane) is a layer of scar tissue that grows on the surface of the retina, particularly the macula, which is the part of your eye responsible for detailed, central vision.
A macular pucker can occur with age. As we grow older, the thick vitreous gel in the middle of our eyes begins to shrink and pull away from the macula. As the vitreous pulls away, scar tissue may develop on the macula. Sometimes the scar tissue can warp and contract, causing the retina to wrinkle or become swollen or distorted. This can lead to vision becoming blurry and distorted, and you may develop a blind spot in your central vision.
Symptoms of macular pucker range from mild to severe. Usually macular pucker affects one eye, although it may affect the other eye later. Vision loss can vary from none to severe vision loss, although severe vision loss is uncommon. A macular pucker does not affect your side (peripheral) vision. For most people with macular pucker, their vision remains stable and does not worsen over time.
OCB’s highly experienced retina team specializes is a leading referral center for conditions of the retina. If your OCB ophthalmologist suspects a macular pucker, he or she will dilate your pupils to examine your retina. You may have a test called fluorescein angiography that uses dye to illuminate areas of the retina, and another imaging test called optical coherence tomography (OCT). OCT is helpful in diagnosing macular abnormalities that are too small to be seen in an examination or with angiography.
After your exam, your OCB ophthalmologist will determine which therapies are best for you based on the severity of the macular pucker and your unique individual needs and concerns. For mild symptoms, you may not need treatment. Updating your eyeglass prescription or wearing bifocals may be all that is needed to improve vision.
For more severe symptoms, a surgery called vitrectomy may be recommended. The surgery is usually performed as an outpatient procedure in an operating room. During surgery, your OCB ophthalmologist uses microsurgery instruments to remove the wrinkled tissue on your macula and to remove the vitreous gel that may be pulling on the macula. Sometimes an air or gas bubble is placed in the eye to help the retina heal or to seal any tears or holes.
After the tissue is gone, the macula flattens and vision slowly improves. In most cases, while visual distortion caused by macular pucker is significantly reduced, it generally does not return to normal.