Eye Disease Macular pucker photo

Published on September 5th, 2016 | by ddeupree


What is macular pucker or epiretinal membrane?

What is macular pucker? A guide to its causes, treatments and surgery options

Other Names for macular pucker: Epiretinal membrane, pre-retinal membrane, cellophane maculopathy, pre-macular fibrosis, retina wrinkle.

What is macular pucker?


Click here to watch the “How vision works” movie


Sometimes when the vitreous pulls away from the retina, there is a small amount of damage to the retina’s surface. When this happens, the retina begins a healing process to the damaged area and forms scar tissue, or an epiretinal membrane, on the surface of the retina. This scar tissue is firmly attached to the retina’s surface. When the scar tissue contracts, it causes the retina to wrinkle, or pucker, usually without any effect on central vision. However, if the scar tissue forms over the macula, our sharp, central vision becomes blurry and distorted.

See a macular pucker surgery video here

What causes a macular pucker?


A macular pucker can also be triggered by certain eye diseases and disorders, such as a detached retina and inflammation of the eye (uveitis). Also, people with diabetes sometimes develop an eye disease called diabetic retinopathy, which can cause a macular pucker. Trauma from either surgery or an eye injury can also cause a macular pucker.

What are the symptoms of a macular pucker?


Macular pucker epiretinal membrane


No. A macular pucker and age-related macular degeneration are two separate and distinct conditions, although the symptoms for each are similar. Your retinal specialist will know the difference.

Can macular pucker get worse?


Is a macular pucker similar to a macular hole?

A macular pucker and a macular hole are different conditions, although they both result from the same reason: the pulling on the retina from a shrinking vitreous. When the “pulling” causes microscopic damage, the retina can heal itself; scar tissue, or a macular pucker, can be the result. If the shrinking vitreous pulls too hard, it can tear the retina, creating a macular hole, which is more serious. Both conditions have similar symptoms – distorted and blurred vision.

What is macular pucker surgery

A macular pucker sometimes requires no treatment. In many cases, the symptoms of vision distortion and blurriness are mild, and no treatment is necessary. People usually adjust to the mild visual distortion, since it does not affect activities of daily life, such as reading and driving. Eye drops, medications, nor nutritional supplements will improve vision problems from epiretinal membrane. Sometimes the scar tissue–which causes a macular pucker–separates from the retina, and the problem clears up.

Click here to watch a vitrectomy animation

Sometimes, vision deteriorates to the point where it affects daily routine activities. When this happens, surgery may be the best option. This procedure is called a vitrectomy, in which the retinal surgeon removes the vitreous gel to prevent it from pulling on the retina and replaces it with a salt solution (because the vitreous is mostly water, you will notice no change between the salt solution and the normal vitreous). The surgeon also removes the scar tissue causing the wrinkling. A vitrectomy usually requires local anesthesia. You can watch an animation of a vitrectomy surgery here.

After the operation, you will need to use medicated eye drops to protect against infection and swelling.

Macular pucker surgery

How successful is this surgery?

Surgery to repair a macular pucker is very delicate, and while vision improves in most cases, it does not always return to normal. Some people enjoy significantly more vision improvement, some less. In most cases, patients notice a significant improvement in vision distortion. Recovery of vision can take up to three months.

What are the risks of surgery?

The most common complication of a vitrectomy is an increase in the rate of cataract development. Cataract surgery may be necessary within a few years after the vitrectomy. Other less common complications are retinal detachment either during or after surgery, and infection after surgery. Also, the membrane may grow back, although this is rare.

Click here to watch a Cataract Surgery animation




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, the surgeon injects fluid between the membrane and the retina that allows the membrane, along with the scar tissue, to lift away. The surgeon then uses forceps to remove the membrane.

Watch a vitrectomy animation


See also…

Membrane peel eye surgery

Sutureless Retina Surgery

Vitrectomy surgery


Some information courtesy of the National Eye Institute

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