This condition has a variety of names, all of which relate to the same findings. These include epiretinal membrane, cellophane maculopathy, and premacular gliosis. All these terms describe 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 complaints. 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.

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. 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.

Questions Reguarding Macular Puckers:

What are some of the ocular complications associated with vitrectomy surgery for macular puckers?

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. If a cataract is present pre-operatively, often we recommend concurrent cataract surgery. 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.

What are restrictions after 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.

Is this condition associated with any other macular problems?

This condition is a distinct clinical entity. Many different conditions having the term macula in it are due to the fact that the same central area of the retina as a macula pucker can be affected in these other conditions. There is no association between a macular pucker and macular degeneration. Rarely do macular puckers result in macular hole formation.

What is the visual prognosis associated with macular puckers?

This depends on many different issues issues including how long the pucker has been present, whether there is associated retinal vascular leakage, or if there is a significant cataract. Statistics show that the majority of patient's visual improvement is at least 3 lines achieved, but again this depends on the preexisting findings. Some patients may achieve 20/20 vision, although this is less likely. Typically symptoms such as distortion and blurriness are alleviated with successful surgery.