Macular Pucker

Overview

Macular Pucker, also known as Epi-Retinal Membrane (ERM) is an eye condition in which there is abnormal mass of cell growth above the region of the macula.

In the normal progression of an aging eye, the jelly substance (vitreous) contained within the eyeball tends to shrink and pull forward (towards the iris). As a result of this pulling, the retina, which has strong attachments to the vitreous at the macula, is pulled which creates traction and puts stress on the retinal cells in the area. In response to the traction that is occuring, a healing response is initiated in some individuals, which brings cells into the area. The formation of a thin layer of these cells is referred to as Cellophane Retinopathy. As these cells thicken and contract, a scar is essentially formed, which is known as a Macular Pucker.

Macular pucker is most often seen in individuals who are 75 years of age or older. It can occur either for unknown reasons (which is most common) or as a result of an associated eye condition such as diabetic retinopathy, posterior vitreous detachment, or retinal detachment.

Signs & Symptoms of Macular Pucker

In the early stages of cellophane retinopathy, there are generally no symptoms although an observant eyecare professional may pick up on signs within the retina. As the condition progresses to a macular pucker, patients begin to notice blurred vision as well as metamorphopsia (distortion of vision), and possibly double vision (diplopia) that occurs even when the other eye is closed.

Detection & Diagnosis of Macular Pucker

The eye doctor is able to detect a macular pucker by examining the inside of the eye with an ophthalmoscope. The macular pucker typically takes on a sheen appearance. To assess visual acuity a standard eye chart will be used. An Amsler grid is used to assess distortion of vision. If swelling of the macula is suspected, fluorescein angiography may also be necessary.

Macular Pucker Treatment

As long as the macular pucker isn't causing significant distortion and loss of visual acuity, no treatment is administered. Once the visual acuity becomes significant to the point that it impairs the patient's lifestyle, a surgical procedure known as a vitrectomy can be performed, in which the vitreous is removed. Surgery is usually delayed as long as possible due to the fact that the surgery poses a significant risk of worsening vision even further.

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