What is Macular Pucker?
Macular pucker is known by several other names such as epiretinal membrane, macular wrinkle, cellophane maculopathy, epimacular membrane, and preretinal membrane.
Macular pucker is characterized by a membrane on the surface of the macular portion of the retina composed of variety of cells including retinal glial and retinal pigment epithelial cells. These cells are nearly translucent and proliferate on the surface of the retina.
What Causes Macular Pucker?
Idiopathic is the most common form of macular pucker. Vascular diseases, ocular inflammatory processes, ocular surgery, and trauma can contribute to the formation of a macular pucker.
Incidence of Macular Pucker
The average age of a person developing macular pucker is approximately sixty five. It occurs in about one percent of the population each year. The likelihood of getting macular pucker in the second eye is less than five percent per year. There is no difference between the sexes.
Symptoms of Macular Pucker
Blurred vision, distorted vision (metamorphopsia), monocular double vision, and/or ghost images are common symptoms. Many people are asymptomatic.
Diagnosis of Macular Pucker
The diagnosis is made by performing a thorough dilated complete eye exam. Other tests may be performed such as Optical Coherence Tomography (OCT) and Fluorescein angiography.
Examination of the macular portion of the retina shows atypical sheen or reflection form the retina in many cases. The structures of the retina are distorted as well as the pattern of the blood vessels in the retina. There can be some changes in the color of the retina.
There may be edema in the macula. There may be pseudohole like appearance in the fovea of the macula.
Macular OCT Findings
Macular OCT may show traction on the surface of the retina with a thin membrane on the surface. There can be a loss of the normal shape and structure of the fovea of the macula. Macular edema may also be present. OCT can be used to follow the course of the disease.
Fluorescein Angiography Findings
Fluorescein can help in cases associated with vascular disease.
Treatment of Macular Pucker
The course of macular pucker varies widely. People may develop macular pucker that does not advance and may only need to be followed. In other cases it may continue to progress with significant loss or blurred vision. There is no medical treatment for macular pucker.
Surgical Treatment of Macular Pucker
The surgical treatment involves performing a vitrectomy with removal of the membrane. A special gas is then placed in the back of the eye (posterior chamber) to help smooth the cells in the macula area. The patient has to keep their head down for a few days to keep the gas bubble in the proper location inside the eye.
The vision return after surgery can take some time as the retina returns to its correct anatomical position.