Retina

Macular Pucker

Overview

Macular pucker (also called epiretinal membrane) happens when wrinkles, creases, or bulges form on your macula, a small area in the center of the retina that allows us to see fine details clearly. The macula must lie flat against the back of your eye to work properly. When the macula wrinkles or bulges, your central vision is affected.

With macular pucker, things can look wavy, or you may have trouble seeing fine details. You might also notice a gray, cloudy, or blank area in your central vision. You may even have waviness in your central vision where straight lines look crooked or wavy. Macular pucker will not affect your peripheral (side) vision.

Causes

Age is the most common cause of macular pucker. As you get older, the vitreous, a clear gel that fills the middle of the eyeball, begins to shrink and pull away from the retina. Usually, the vitreous pulls away with no problems. But sometimes the vitreous can stick to the retina causing scar tissue to form.  The macula then develops wrinkles or bulges from this scar tissue.

Risk Factors

Aging is the most common risk factor for macular pucker. People who have other eye problems may also get a macular pucker. These problems include:

  • Posterior vitreous detachment, where the eye’s vitreous pulls away from the retina

  • Torn or detached retina

  • Swelling inside the eye

  • Previous surgery or serious damage to the eye from injury

  • Problems with blood vessels in the retina

Treatment

How you are treated depends on your symptoms.  If your symptoms are mild, you might not need any treatment. Instead, your ophthalmologist may change your glasses or contact lens prescription to improve your vision. You might also choose to wear bifocals when you are looking at something close. Eye drops, medicine, and laser surgery do not help vision if you have macular pucker. However, your ophthalmologist may prescribe these treatments if you have other conditions mentioned above. 

If your symptoms are more serious, your ophthalmologist may recommend a surgery called vitrectomy. Your ophthalmologist will remove some of the vitreous and scar tissue on your macula. This flattens the macula, returning it to its proper position. It is likely your vision will slowly improve. However, your eyesight may not be as good as it was before macular pucker.

Vitrectomy Surgery Risks

Like all surgery, vitrectomy has some risks. They include:

  • Eye infection

  • Bleeding in your eye

  • A detached retina (where the retina lifts away from the back of the eye)

  • Having the macular pucker happen again

  • Developing a cataract, which is when the lens in your eye becomes cloudy

 

Your ophthalmologist will inform you of these risks and how vitrectomy surgery may help you.

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