Epiretinal membrane, cellophane maculopathy, retina wrinkle and
What is a macular pucker?
The macula is a tiny oval area made up of millions of nerve cells
located at the center of the retina. The retina is the
light-sensitive tissue at the back of the eye that sends visual
signals to the brain through the optic nerve. The macula is
responsible for sharp, central vision. A macular pucker or
epiretinal membrane is scar tissue that has formed on the retina.
What causes a macular pucker?
As we age, the vitreous, the jelly-like substance inside the eye
that makes the eye round, changes consistency and starts to shrink.
This shrinking causes the vitreous to pull away from the retina and
scar tissue may develop. If this scar tissue contracts, it causes
the retina to wrinkle. Other causes of macular pucker include trauma
(from either surgery or an eye injury), retinal detachment,
inflammation, and problems with the retinal blood vessels.
What are the symptoms of a macular pucker?
If the retinal wrinkling happens in the macula, patients may
notice that their vision is blurry or mildly distorted and straight
lines can appear wavy.
How is a macular pucker treated?
The only treatment for this condition is surgery. Since surgery
always involves risks, it is recommended only for patients whose
vision is significantly affected. In most cases, treatment is not
recommended. Patients should talk with their eye care professional
about whether treatment is appropriate.
Surgery consists of a vitrectomy combined with peeling away of
the scar tissue. During a vitrectomy, the vitreous and scar tissue
are removed. The surgeon then replaces the vitreous with salt
Most patients recover about half of their lost vision, and
distortion is significantly reduced. The most common complication of
vitrectomy is an increase in the rate of cataract development.
Cataract surgery may be needed within a few years after the
vitrectomy. Other, less common complications are retinal detachment
either during or after surgery and infection after surgery. The
macular pucker may grow back, but this is a rare occurrence.
Research studies are being conducted to determine other
treatments for macular pucker. Please note that both of the
procedures described below need additional clinical testing. We
suggest you share this information with your eye care professional.
Some physicians are researching the use of a surgical procedure
in which scar tissue is peeled off without performing the
Other doctors are researching a new surgical technique to remove
the internal limiting membrane (a layer of the retina) for patients
with both macular pucker and macular hole. This surgical technique
is called Fluidic Internal Limiting Membrane Separation (FILMS).
After a vitrectomy, fluid is injected between the membrane and the
retina that causes the membrane, along with the scar tissue, to lift
away. It is then removed with forceps.
Keeping on Top of Your Condition
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The following organizations may be able to provide additional
information on macular pucker:
National Eye Institute
2020 Vision Place
American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
Distributes a fact sheet on macular pucker for
For additional information, you may wish to contact a local