MACULAR PUCKER
Aliases: EPI membrane (epiretinal, ERM, or epithelial) membrane, preretinal
membrane, cellophane retinopathy or maculopathy, retina wrinkle, surface wrinkling
retinopathy, premacular fibrosis, and internal limiting membrane disease.
All of these names relate to the fact that there is a layer of thin scar tissue on the
surface of the macula which result in mechanical wrinkling and distortion of the
retina leading to decreased vision.
What is a Macula?
The macula, a specialized area of the retina (located on the inside back of the
human eye), is responsible for sharp, clear, detailed vision. A Macular Pucker is an
abnormal growth of cells over the macula which can cause blurring and distortion
of the central vision.
Symptoms are really no different than other conditions affecting the central
retina. These include:





Distorted, “wavy” vision, (e.g., straight lines have a bend) while
reading
Blurred central vision for distance and reading activities
Difficulty reading or performing tasks that require see detail
Gray area in central vision
Central blind spot distortion when looking at TV screens
How does it occur?
Most ERMs or macular puckers are related to vitreous detachment, which usually
occurs in people over 50. As you age, you are at increased risk for macular
pucker, secondary to the vitreous detachment. For most people, vision remains
stable and does not get progressively worse. Usually macular pucker affects only
one eye, although it may affect the other eye at a later date.
A macular pucker can be triggered by certain eye diseases and
disorders, such as a detached retina and inflammation of the eye
(uveitis). Also, people with diabetes sometime develop an eye disease
called diabetic retinopathy, which can cause a macular pucker, as well
as swelling of the macula. It can also be caused by trauma from either
surgery or an eye injury.
Diagnosis is made when an ophthalmologist performs a dilated retinal
examination and examines the back of the eye.
System of Events: In order to maintain its round structure, the central portion of
the eye is filled with vitreous. As a person ages, this gelatin-like substance begins
to shrink and contracts towards the front part of the eye. As this shrinkage of the
vitreous progresses, the retina can become overexerted, resulting in microscopic
damage to its inner surface. When the vitreous separates itself from the macular
area, there are normally no negative effects, but when there was a firm
attachment that's been removed, superficial irritation triggers a healing response
to occur. The retinal cells then spread outward to help the “healing” process along
the surface of the retina. This “healing” response causes the thin layer of scar
tissue referred to as a macular pucker.
Treatment: In many cases when minimal vision loss occurs, no treatment is
recommended. But, in the remaining few cases, vision loss may impact driving or
reading; therefore, a surgery known as a vitrectomy, may be recommended.
Basically, a vitrectomy is the removal of vitreous fluid that is replaced with a
substitute.
__________________________________________________________
Sources:
Cassin, B. & Rubin, M. L. (Ed.). (2006). Dictionary of Eye Terminology (5th ed.).
Gainesville, FL: Triad Publishing Company.
Clayman, C. B. (Ed.). (1994). The American Medical Association Family Medical
Guide (3rd ed.). New York: Random House.
Epiretinal Membranes/Macular Pucker. (n. d.). Eye Centers of Florida. Retrieved
July 8, 2010, from http://www.ecof.com/florida-lasik-fortmyers/epi_retinal_membranes_macular_pucker_retina_center/epi-retinalmembranes-macular-pucker.html
Information about Macular Pucker. (n. d.). Mama's Health. Retrieved July 9, 2010,
from http://www.mamashealth.com/eye/macpuck.asp
Macular Pucker. (n. d.). Vitreous-Retina-Macula Consultants of New York.
Retrieved July 6, 2010, from http://www.vrmny.com/pe/mp.html
Compiled by Charlotte Conner, M.Ed