What is a Macular Pucker?
A macular pucker is a condition where the center of the retina becomes distorted or puckered. The retina is the light-sensing tissue that lines the inside back part of your eye. Most of the retina is devoted to peripheral vision, night vision, and sensing motion. The macula, or central retina, is the only area that is able to visualize fine detail or provide reading vision.
In a person with Macular Pucker, a thin film of tissue grows over the surface of the macula. If this tissue contracts, the macula can become distorted and swollen, which usually results in blurred and distorted vision.
Terminology for Macular Pucker:
There are three standard terms to describe distortion of the central retina from epiretinal tissue:
- Epiretinal Membrane (ERM) or Cellophane Retinopathy:
- Cellophane Retinopathy or Epiretinal Membrane refers to a thin film of tissue that grows or proliferates over the macula.
- Macular Pucker:
- A Macular Pucker occurs when an Epiretinal Membrane or Posterior Vitreous adheres to the macula and contracts, which causes distortion or puckering of the macula.
- Vitreomacular Traction:
- Vitreomacular Traction refers to an incomplete separation of the vitreous from the retina where the posterior or back edge of the vitreous remains attached to the central macula. The adherent edge of the posterior vitreous can exert varying amounts of traction or tugging on the macular tissue, which can then distort or pucker the macula.
Who is at risk for a Macular Pucker?
In the majority of patients with macular pucker, no underlying cause is found. There are a few associations of macular pucker with other pathologies such as:
- Retinal tears,
- Posterior vitreous detachment,
- Retinal detachment,
- Diabetic retinopathy, and
What are the symptoms of a Macular Pucker?
- Blurred vision is the main symptom of macular pucker. It can occur when the macula becomes either swollen or distorted from epiretinal tissue. As the contraction and adherence of epiretinal tissue worsens, the macula and central vision may become distorted so that straight lines appear curved. If the swelling or distortion is severe enough or is untreated for a long period of time, the central retina will begin to lose function, and a central spot or blurred area can develop.
- Floaters can appear as spots, that interfere with vision. Although macular pucker does not directly cause floaters, it is important to note that floaters can be an important sign of associated syndromes, such as retinal tear, posterior vitreous detachment, and diabetic retinopathy.
What tests might be ordered?
After a complete eye examination, your doctor may order:
A test of the macular anatomy called Optical Coherence Tomography (OCT). OCT is the standard test to diagnose and quantify macular thickness, swelling, and distortion from the epiretinal membrane, as well as to gauge treatment effectiveness and aid in visual prognosis.
Or a test of the retinal circulation called Fluorescein Angiography (FA). FA is used to complement the OCT findings and can detect subtle and specific patterns of leakage, which can help to optimize treatment. To perform an FA, a vegetable-based dye (fluorescein) is injected into your arm, and then special photos are taken of the inside of your eye. As the dye passes to your eye, more photos are taken to document blood flow and potential leakage.
What treatment is available?
- Vitrectomy surgery is the most direct and definitive way to correct a macular pucker. Although the vision does not typically return to normal following vitrectomy, most patients notice significant vision improvement, and symptomatic distortion is improved in the vast majority of patients. Vitrectomy surgery is performed in an operating room and is similar to catactact surgery. The majority of both cataract and vitrectomy surgeries are stitchless. During vitrectomy surgery, the vitreous is removed, thereby eliminating any vitreomacular traction. Any residual preretinal tissue over the macula is then removed with microscopic forceps.
- Intraocular injections are being used to treat secondary macular swelling associated with macular pucker. These injections are performed in the office and can be used alone or in conjunction with vitrectomy surgery. The more comprehensive approach of both injections to treat swelling and minimally invasive vitrectomy surgery usually accomplishes return of vision for most patients within a few weeks of surgery.