Epiretinal Membranes / Macular Pucker

What is the Macula?

The macula is the small area at the center of the eye’s retina that is responsible for the sharp central vision we need for reading, driving and seeing details clearly.  An epiretinal membrane, sometimes referred to as a macular pucker, is an abnormal growth of cells over the macula.

The human eye is shaped like a ball measuring approximately one inch across.  Most of the eye’s interior is filled with vitreous, a gel-like structure that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina.  As we grow older the vitreous begins to shrink and pulls away from the retinal surface.  This is called vitreous detachment and is normal and usually does not result in significant visual damage, though you may notice a small increase in floaters. 

However, sometimes when the vitreous pulls away from the retina, there is microscopic damage to the retina’s surface.  When this happens the retina begins a healing process in the damaged area and forms scar tissue, or an epiretinal membrane, on the surface of the macula. 

What causes a Epiretinal membrane (ERM)/Macular Pucker?

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.

A macular pucker can also 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.

What are the symptoms of an Epiretinal membrane /Macular Pucker?

The symptoms are similar to most conditions affecting the central part of the retina, the macula.  These include:

• Blurred central vision
• Distorted, “wavy” vision, e.g., straight lines have a bend
• Difficulty reading or performing tasks that require see detail
• Gray area in central vision
• Central blind spot

How is the diagnosis of Epiretinal membrane / Macular Pucker made?

During your eye exam your eye care provider will perform a dilated retinal examination. This dilation of the pupil will enable your doctor to see the internal details of your eye and enable an assessment of the entire retina, including the macula.

How is an Epiretinal membrane / Macular Pucker treated?

Usually a macular pucker requires no treatment. This is due to the fact that in many cases the symptoms of vision distortion and blurriness are mild.  People often adjust to the minimal vision distortion.  Sometimes the scar tissue – which causes a macular pucker spontaneously separates from the retina and the macular pucker clears up.

In some cases the visual distortion is significant and surgery may be recommended.  This surgical procedure is called a vitrectomy, in which the vitreous gel is removed. The vitreous cavity is re-filled with a clear liquid, a gas bubble, or other vitreous substitutes. Visual recovery is slow and may take as long as six months.  You will need to wear an eye patch for a few days to protect your eye.  You will also need to use medicated eye drops to protect against infection.

As with all surgical procedures there are complications and risks associated with the repair of macular pucker.  The most common complication of a vitrectomy is an increase in the rate of cataract development.  Less common complications include retinal detachments either during or after surgery, and infection after surgery. Since the macular was distorted by the membrane, recovery of the eyesight may be very slow or not at all.

Please refer to the following organizations for more detailed information on macular pucker:   Association for Macular Diseases and The Foundation Fighting Blindness.

Other names for an Epiretinal Membranes / Macular Pucker:

Epi-Retinal Membranes, preretinal membrane, cellophane maculopathy, retina wrinkle, surface wrinkling retinopathy, premacular fibrosis, and internal limiting membrane disease.