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Macular Pucker Fact Book

Table of Contents

Other Names

Epiretinal membrane, cellophane maculopathy, retina wrinkle and premacular fibrosis.

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.

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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 solution.

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.

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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 vitrectomy.

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.

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The following organizations may be able to provide additional information on macular pucker:

National Eye Institute
2020 Vision Place
Bethesda, MD 20892-3655
(301) 496-5248

American Academy of Ophthalmology
P.O. Box 7424
San Francisco, CA 94120-7424
(415) 561-8500
Distributes a fact sheet on macular pucker for patients.

For additional information, you may wish to contact a local library.

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