Macular Pucker

Also called epiretinal membrane and cellophane maculopathy macular pucker refers to the presence of a membrane over the surface of the macula. The macula is the central region of the retina, it is responsible for providing fine vision for such tasks as driving, reading, and watching television. It is the size of a pinhead and is the part of the eye that is most responsible for detailed vision. Any pathology associated with this area will result in visual complications. Macular Pucker comes about as the normal vitreous gel breaks up as we age. It then separates from the retinal surface. This can cause irritation or damage to the retina and its subsequent healing response by cells found within the retina tends to repair the area forming a membrane. These conditions can occur in patients without any previous ocular history or can occur after surgery for other ocular procedures.

Most patients with macular puckers may be asymptomatic or may have normal vision. When symptoms occur the visual disturbance can vary from mild distortion to blurred vision. The onset is slow but visual symptoms can sometimes become progressive.

Pupil dilation is essential to diagnose macular pucker. A fluorescein angiogram may be recommended to help evaluate whether there is leakage in the retina associated with the gliotic or scar tissue.

Treatment is not indicated unless the patient is bothered by his symptoms. A small percentage of patients may have spontaneous resolution of this condition as the membrane has been known to spontaneously retract from the retinal surface. Surgery can be considered if the patient’s visual complaints are disturbing and create difficulty for them functioning. It also considered if there is significant leakage noted on fluorescein angiography which would cause a risk to the patient’s vision over time. Surgery is typically performed in an ambulatory setting under local anesthesia, although general anesthesia can be utilized. The surgical procedure includes that of a vitrectomy where the vitreous gel is removed from the eye. A light source is used to illuminate the eye while an instrument is used to remove the vitreous gel. Specialized instruments are then used to peel the scar tissue from the retinal surface.

It may take up to 2 – 3 months to gain back the majority of vision after the surgery. However, patients who have had macular puckers present for extended periods of time or have significant leakage may take longer for recovery.

The most common complication that can occur after macular pucker surgery is that of progression of a cataract. The infusion solution utilized throughout a vitrectomy procedure may cause lens irritation. This results in cataract progression most likely resulting in cataract surgery at an earlier stage in life than necessarily might have been without surgery. Rarely does a cataract progress during the course of the procedure necessitating its removal at the time of surgery. We would suggest that the cataract be removed at a later date by a general ophthalmologist in conjunction with an implantation of a lens when the patient’s condition has stabilized and when it is felt that its removal will be visually helpful. Other problems that can occur during a vitrectomy include the development of a retinal tear and detachment. These are diagnosed in the operating room at the time of the vitrectomy and treated accordingly. A small percentage of times an air bubble is needed requiring the patient remain in a prone position for a few weeks after surgery.
Restrictions following surgery:
In most cases recovery can take up to a week before a patient may resume his normal activities. If an air bubble is utilized due to the presence of a retinal tear, then it would be necessary to remain in a prone position for up to 2 – 3 weeks and to avoid air travel as long as there is an air bubble present.