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Macular Pucker

Macular pucker is a condition that has multiple synonyms including: epiretinal membrane, cellophane retinopathy, epimacular membrane, preretinal membrane, premacular fibrosis or retinal wrinkling. It is a disease caused by scar tissue collection on the macula that causes distortion and/or blurry vision. The scar tissue is visible on the retina during a careful dilated exam and further assessed by an optical coherence tomography. Even though this condition occurs in the same place in the retina as age-related macular degeneration (the macula), it is a different condition.

What Causes Macular Pucker?

When person has a posterior vitreous detachment (link to section on PVD), the eye sometimes responds to the micro-abrasive trauma of this event by forming scar tissue. This scar tissue can proliferate on the surface of the retina and cause wrinkling of the surface. Certain inflammatory disease of the eye (uveitis), trauma, retinal detachment or tears or bleeding inside the eye can make the eye more susceptible to forming epiretinal membrane.

Why Does Epiretinal Membrane Cause a Distortion in Vision?

This wrinkling of the surface of the retina can cause distortion because it changes the orientation of how light hits the retina. For example, if you project a movie onto a wrinkled projector screen, straight lines will appear wavy. Similarly, if an image is projected on a wrinkled retina, the image information will be relayed from the retina to the brain in a distorted manner.

What Is the Treatment of Macular Pucker?

If the vision is being affected (wavy or blurred vision), the patient can be treated with a surgery called pars plana vitrectomy with membrane peel. The purpose of this surgery is to physically peel the scar tissue off the retina inside the eye so that the retina can flatten out and settle back to a non-wrinkled orientation. The retina will then need to heal after surgery and visual improvement can take 2–4 months. In addition, the vision may continue to improve 6 to 12 months after surgery as the retina remodels after surgery.

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