Macular Pucker

Macular pucker, also known as an epiretinal membrane, is most commonly associated with people over 50. It is the formation of scar tissue over the macula, or the central part of the retina. The retina is the light-sensitive film at the back of the eye that converts light into an electrical signal that can be interpreted by the brain.

The macula is a critical part of the eye and is responsible for detailed vision. Although very small, the macula has the highest concentration of the cells in the retina that change light to electricity, called photoreceptors. These are the cells that allow us to read, see faces, and drive a car. Damage to these cells is the cause of vision loss in macular degeneration.

The most obvious symptom of a macular pucker is a change in one's vision, although it may range from no or little to severe distortion. People with macular pucker may notice their vision is distorted or blurry, and straight lines may appear wavy. They may also have trouble reading small print or seeing fine details. It is possible to have a gray area in their vision or to just have a central blind spot. An amsler grid is useful in detecting these changes. Using an amsler grid on a daily basis is a good way to determine if one's vision is getting worse.

One of the most common causes of macular pucker is the body's own aging process. Most of the interior of the eye is filled with vitreous, a jelly-like substance that fills about 80% of the inside of the eye and helps to maintain its shape. As we age the vitreous starts to shrink and cause traction, or pulling on the surface of the retina. This is also known as a post vitreous detachment, which occurs in about 75% of the population over the age of 65.

In this process, this traction sometimes causes microscopic damage which initiates a healing response. This response causes cells to gather over the damaged area which forms a thin layer of scar tissue also known as macular pucker. Macular pucker may also occur after intra-ocular surgery, particularly in cases with retinal detachments. They may also form if there is inflammation, or swelling, inside the eye. Holes, tears, or trauma to the eye can all cause formation of this membrane. An onset of flashing lights or floaters may also be a warning sign that a change is taking place in your eye.

Since post vitreous detachments are a natural part of the aging process, there is no good evidence for any preventative measures. However, since the epiretinal membrane seems to be a protective response to the PVD, it is possible that the imflammation that occurs may be treated by a course of NSAIDS, or non-steroidal anti-inflammatory drops. These drops may help to reduce the amount of swelling and progression of the membrane.

In most cases it is unnecessary to treat the macular pucker since its effects on ones vision is minimal. It may be enough to prescribe some NSAIDS and carefully watch the epiretinal membrane for progression. However in some cases the distortion and loss of vision is significant. In these instances, surgery may be recommended by the doctor.

This surgery is called a vitrectomy, which is a surgical procedure where some of the vitreous is removed from inside the eye and is replaced with gas or silicone oil. The scar tissue is then gently peeled away from the surface of the retina, which relives traction and helps reduce the distortion in the patients vision.