Macular pucker, also known as an epiretinal membrane or cellophane maculopathy, is a membrane on top of the retina that can lead to significant decreased central vision or distortions.
WHAT IS A MACULAR PUCKER?
The macula is the central part of the retina responsible for your most detailed vision. The macula has the highest density of photoreceptors and more specifically the highest density of cones which are the photoreceptors in charge of color vision. It is also the part of our vision we use to read, drive and recognize faces. Diseases of the macula affect our central vision and thus can significantly affect our visual function.
A macular pucker is the growth of a membrane on top of the retina that contracts and causes wrinkling and swelling of the retina which affects the proper functioning of the cells within the retina. It is most commonly secondary to the changes that happen within the vitreous gel that fills the back part of the eye. The gel starts to liquefy as we age and separates from the retina. This separation of the gel is a common occurrence that happens as we age and causes the release of cells within the retina that start to proliferate on top of the retina and with time contract. That is why macular puckers are so common as they are found in about 10% of people over the age of 50. (Other processes such as inflammation of the eye or retinal tears or detachments can increase your risk of having a macular pucker and need to be evaluated by your eye specialist). This process translates into decreased central vision and the presence of distortions in which patients see straight lines as wavy.
AM I A GOOD CANDIDATE FOR MACULAR PUCKER SURGERY?
The growth of a macular pucker is slow and not every patient with a macular pucker requires treatment. At Retina San Diego, we evaluate every patient and assess how your disease is affecting your visual function in your life in addition to using the latest retinal imaging technology. If a macular pucker does not affect your vision significantly then it can be observed. However, for patients who have significant symptoms of distortions or significantly decreased central vision, surgery is an option in order to remove the macular pucker.
WHAT IS THE TREATMENT FOR A MACULAR PUCKER?
Macular pucker surgery although very successful, is never an emergency as membranes on top of the retina grow very slowly. Surgery is only indicated for patients who have a significant decrease in vision or whose visual changes significantly affect their functioning.
The treatment for a macular pucker is a surgery called: "Vitrectomy and membrane peel". During the vitrectomy step, the vitreous gel that fills the back part of the eye is removed in order to allow the removal of the membrane. Then the macular pucker is gently peeled off the top of the retina with microforceps that are visualized under a microscope. The surgery is done on an outpatient basis.