What Is a Macular Pucker?

By John Choi, MD

Chesapeake Retina Centers

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What Is a Macular Pucker?

The macula is a specialized part of the retina. If there are problems with the macula, it will affect one's central vision. An epi-retinal membrane is scar tissue on the surface of the retina.

The macula should be flat and smooth against the back wall of the eye. Scar tissue anywhere in the body will contract. Scar tissue is part of the healing process of the body and this contraction is often needed. When the scar tissue or membrane contracts, it pulls into itself, so the underlying retina looks pinched together or puckered. This is why an epi-retinal membrane is also known as a macular pucker.

One way there can be loss of vision, is simply because the macula is covered by scar tissue. This will not allow light to pass through to the retina. Most of the effects on vision, however, are related to the puckering or distortion of the macula.

The more the scar tissue contracts, the more distorted the vision becomes. Occasionally, the image the brain sees will be clear, but it is dragged out of position and no longer matches the other eye. When this happens, there is double vision.

Scar tissue forms as a response to any damage or injury to the retina or surrounding structures. This injury could be infection or inflammation of the retina. It could be as a result of swelling in the retina after cataract or glaucoma surgery.

Damage can also occur from internal bleeding (diabetic retinopathy, strokes of the eye, or due to macular degeneration). The body can even interpret a normal process such as a vitreous separation (cause of floaters) as damage and form scar tissue on the macula to try to repair a non-existent problem.

If the epi-retinal membrane is only distorting the macula slightly, and not causing swelling in the retina, sometimes it can simply be observed. If there is no permanent damage occurring to the retina and the patient is not bothered by the visual distortion, close observation is warranted. If there is swelling in the retina that will damage the retina or the visual symptoms are not tolerated by the patient, surgical repair is likely needed. Surgery is the only way to treat an epi-retinal membrane.

The surgery does not fix the problem. It removes a problem (scar tissue on the retina). Once the scar tissue is removed, the retina will flatten out and the vision will improve. How much the vision improves and how much of the visual symptoms are alleviated, depends on how well the retina flattens. This can be unpredictable and your retina surgeon can help advise on whether surgery for you is indicated or not.