Macular Pucker

A macular pucker is a membrane on the surface of the macula that can adversely affect central vsion.

What is a Macular Pucker?

The macula is the center of your retina. It is responsible for your straight ahead vision. While reading the print on this page, you are using your macula. The cornea and lens in the front of your eye focus the image of these words onto your macula. The macula converts the light from the image on this page into a neurological signal that is processed by your brain. When an extra layer of tissue forms on the retinal surface and then contracts to distort the central retina, we call it a macular pucker. A macular pucker is sometimes called an epiretinal membrane, cellophane maculopathy, a wrinkle, preretinal fibrosis or pseudomacular hole. Macular puckers are present in about 10% of people over the age of 50. They usually caused by a layer of vitreous--the gel that fills the eye--condensing on the surface of the retina and changing into a membrane. They look like a piece of scotch tape. Some macular puckers contract and pull the macula enough to cause distortion in the central vision. When this happens, patients can consider vitrectomy for macular pucker.

What are the symptoms of macular pucker?

The most common symptoms of macular pucker are distortion and vision loss. In is important to realize that other, more serious and more acute disorders can also cause distortion. If you experience new distortion in your vision, DO NOT ASSUME YOU HAVE A MACULAR PUCKER. You may have something more serious. You should consult a physician as soon as possible (less than a week) if you have new onset distortion and vision loss in either eye. Sometimes when one eye has a serious vision problem the other eye will take over and you may not notice the problem. Therefore, it is important to check your eyes separately every day to make sure that each eye is seeing well.

What is a macular pucker evaluation?

The diagnosis of a macular pucker is established by an eye examination and confirmed with ancillary testing. A dilated examination of the macula using a silt lamp (microscope) can usually establish the diagnosis of a macular pucker. Optical coherence tomography (OCT) is a useful tool for assessing the microstructure of the macula. A low energy laser is swept across the macula and a computer uses the reflected light to reconstruct the layers of the retina. An OCT scan will also show a macular pucker and can establish how the macular pucker is distorting the macular structure. Fluorescein angiography can show distortion of vessels in an eye with a macular pucker. It is also sometimes used to eliminate the possibility of other diagnoses, like wet age-related macular degeneration and retinal vein occlusion.

What is the Natural history of macular pucker?

Macular puckers are usually stable. They generally form and affect vision over a time period of about 3 months and then rarely change. One study followed 84 patients with macular pucker for a year, half with cataract surgery and half without, and there was virtually no change in any of the patients’ macular puckers. Visual acuity and retinal thickness was minimally worse at one year in some patients.(Eye. 23(4):774-9, 2009)

A population-based study of people living in the Blue Mountains west of Sydney, Australia, was performed following all people living in that area for common eye diseases. This study identified, by photography, 2 types of macular pucker – one type that caused retinal folds (premacular fibrosis) and one type that did not cause retinal folds (cellophane maculopathy). At the studies inception, 56 participants (62 eyes) had premacular fibrosis. The lesions progressed in 16.1% of eyes and regressed in 25.8% of eyes. Of the 142 participants (183 eyes) with cellophane maculopathy, the area of involvement decreased in 12.6% of eyes and disappeared in 13% of eyes.(Ophthalmology 2003;110:34–40)

A clinic based study showed that 15% of patients with macular pucker have visual acuity of worse than 20/70. The same study showed no further loss of vision after enrollment in 87% of 47 eyes followed without surgery for 2 to 4 years.(Ann Ophthalmol. 1982;14:876-8)

Several studies have shown that about 25% of people with macular pucker in one eye will develop a macular pucker in the fellow eye.

What are the options?

If you have been diagnosed with a macular pucker you can live with it, wait, have surgery, or if applicable, seek treatment of other disease affecting your vision.

Live with it: Macular puckers are not uncommon. If your vision is not affected by the macular pucker, you do not need surgery. Macular puckers rarely progress. If your macular pucker does progress, you can opt to have it operated on when that happens. If your vision is minimally affected by the macular pucker, you have to weight the risks and benefits of surgery. These are discussed further in the surgery section of this site (see link below). Everyone has different visual needs. There are people who cannot work if there vision is minimally compromised and there are people who get along fine with relatively poor vision. You need to decide what is right for you.

Wait: Since macular pucker surgery is successful at improving vision within the first few years of onset of the macular pucker, there is no harm waiting a little while to decide. About 5% of macular puckers improve with time, about 80% stay the same, and about 15% worsen. Usually if they worsen, they do so within the first few months of onset. So waiting a few months is rarely dangerous. Comparing serial optical coherence tomography scans over time can help you gauge if your macular pucker is changing.

Have Surgery: If you are bothered by your vision and want to have surgery for the macular pucker, there is no benefit to waiting. Although it is OK to wait to have surgery, it is not necessary. You are probably a little better off having surgery sooner than later if you are sure that is what you want. The benefit of surgery probably does gradually decline over time while the risk stays the same. There is no way to tell if your macula has been permanently damaged by the macular pucker. Eighty percent of people improve with surgery, 15% don’t change and about 5% worsen. If your vision is affected to the point where your eye is not seeing well and your visual function is poor, then surgery is a reasonable option.

Seek treatment of other diseases affecting your vision: Many macular pucker patients have other eye diseases, like cataract, macular edema, and retinal vein occlusion. If you have a concomitant treatable eye disorder, treatment of that disorder might improve your vision enough that your visual function is satisfactory to you and you do not need the macular pucker removed. An added benefit of cataract surgery prior to macular pucker surgery is that it makes the macular pucker surgery technically a little easier and probably safer.

What is Vitrectomy for Macular Pucker

Vitrectomy for macular pucker improves the vision in patients 80% of the time about half way to normal. Since, the surgery, like any surgery, has some risks, most surgeons only recommend surgery for patients with significant visual symptoms. If a person with a macular pucker is having trouble reading, driving, or doing whatever they want to do visually surgery can be helpful. Usually this occurs when the visual acuity drops to 20/70 or less. Some patients with visual acuity between 20/40 and 20/70 have symptoms severe enough to warrant surgery. Usually when the vision is better than 20/30 surgery is not recommended because the risk of surgery can outweigh the potential benefits. Without intervention, only about 10 to 25 percent of eyes with macular pucker suffer progressing visual acuity loss. Macular pucker surgery is never an emergency. Macular puckers can be removed within a few years on onset with good visual results. In general the sooner a macular pucker is removed, the more likely the vision will improve. Still there is no harm waiting a few months before considering the operation. A small number, about 5 percent, of macular puckers will spontaneously peel and vision will improve. Most macular puckers are stable.

Video Macular Pucker Surgery

65 year old woman with 20/50 vision for about a year. Vision improved to 20/25 1 week after surgery.



Video Macular Pucker Surgery

This 65 year old woman has had decreasing vision for 6 months from a macular pucker. The visual acuity is 20/200. The patient had cataract surgery 6 months ago and the vision is still hazy and distorted from the macular pucker. Vision improved to 20/30 6 months after surgery.



Video Macular Pucker Surgery

This 60 year old man with 20/400 macular pucker and vision loss over about a year. Vision was 20/80 at 1 month follow-up visit. High definition video - very thick macular pucker (epiretinal membrane).



Macular Pucker NEWS

Below are current articles from a Google News Feed on Macular Pucker


Healio

Measurements of contrast sensitivity and distortion aid surgical decision-making in eyes with macular pucker
Healio
Right now, we only have visual acuity, and that's limited in its ability to really give us a handle on the degree of impact that macular pucker has on vision,” corresponding author J. Sebag, MD, FACS, FRCOphth, FARVO, told Ocular Surgery News.


WABI

Healthy Start- Macular Pucker
WABI
Sometimes macular pucker is the result of an injury or a medical condition, such as diabetes, that affects the eye. Epiretinal membranes can sometimes form after eye surgery, including cataract surgery. The cause of most cases of macular pucker is not ...


Medgadget (blog)

Technological Innovations for Improved Surgical Accuracy Instrumental for Growth of Global Retinal Surgery Devices ...
Medgadget (blog)
This is because age is a major factor that increases the chances of ocular diseases, of which, diabetic retinopathy, macular pucker, and retinal detachment are most common. As per estimates of the World Health Organization (WHO), the global geriatric ...

and more »

Dr. Crane in Ferndale, MI Provides Comprehensive Eye Exams for Patients' Eye Health
Digital Journal
Retinal problems include macular degeneration, diabetic eye disease, retinal detachment, retinoblastoma (cancer), macular pucker (scarring), macular hole, and floaters (spots). After he has determined the patient's exam information, he will then make a ...


Everyday Health (blog)

Dangerous Eye Problems You Should Never Ignore
Everyday Health (blog)
According to the National Eye Institute, some macular holes seal themselves, but surgery may be necessary to improve vision. A macular pucker is the formation of semitransparent scar tissue on the surface of the retina. Over time, the scar tissue can ...

and more »

Daily Mail

Alzheimer's sufferer died after being pinned by a wardrobe in Derbyshire care home
Daily Mail
Giving evidence, she said: 'We discussed the fact she thought she could walk but couldn't really walk and her eyesight was affected by the macular degeneration. 'We asked if she could be monitored if she got out of bed as she regularly got out of bed ...

and more »

Daily Mail

Cause of blindness in elderly could be cured by anti-depressants 'already on sale'
Daily Mail
Millions of people could be prevented from going blind by drugs designed to treat depression and strengthen bones, research suggests. In tests on mice, drugs already on sale for other conditions prevented the first stage of age-related macular ...


Two dosing levels of ranibizumab show good effects in eyes with DME
Healio
Ferrone and Jonisch present a 12-month, single-center, prospective randomized comparison between 0.5 mg and 1 mg ranibizumab for the treatment of refractory clinically significant diabetic macular edema. Patients received three monthly injections ...


As-needed aflibercept resolves persistent, recurrent fluid in eyes with neovascular AMD
Healio
Mean central macular thickness decreased significantly at all visits except month 11 in the multiple recurrence group and month 5 in the persistent group. More frequent injections were required in 37 eyes (45.6%) at a median of 37 weeks to control ...


Daily Mail

The ultimate do's and don'ts when it comes to protecting your eyes
Daily Mail
This means that years of seemingly harmless episodes of UV exposure such as visits to the beach without the right protection could lead to serious problems long term, such as cataracts (where the lens becomes cloudy), age-related macular degeneration ...

and more »

Daily Mail

John Glenn hopes airport being named for him inspires kids
Daily Mail
He said he's lost a quarter to a third of his eyesight as a result of a small stroke and macular degeneration. The aging hero then poked fun at the situation with a couple of jokes. The airport's new name was unveiled at the end of the event. It ...

and more »

Daily Mail

Strawberries can save your sight and prevent cancer
Daily Mail
A study published in the Archives of Opthalmology indicated that eating three or more portions fruit rich in vitamin C may reduce the risk of age-related macular degeneration by 36 per cent. Macular degeneration is the primary cause of vision loss in ...


Achieving optimal outcomes with toric IOLs
Healio
Toric IOLs provide an excellent means of correcting pre-existing corneal astigmatism with cataract surgery. Current studies have shown that the combined residual astigmatism and the spheroequivalent error must be less than 0.5 D for the patient to be ...

and more »

Daily Mail

OrCam headset recognises faces, objects and reads words aloud
Daily Mail
He said: 'Age-related macular degeneration is one of the most common causes of blindness in the elderly and it has no cure in its advanced stages. 'This device offers hope to patients who are beyond medical or surgical therapy for the condition.' 'It ...

and more »

Daily Mail

BROCCOLI could save your sight as vegetable 'helps treat cause of blindness'
Daily Mail
During tests, researchers have found a highly potent concentration of the property could be used to treat age-related macular degeneration, the leading cause of vision loss. To reap the benefits, one would have to eat 'an unreasonable amount of ...

and more »

Argus II retinal prosthesis system shows continued safety, efficacy 5 years after implantation
Healio
The Argus II retinal prosthesis system restored some basic visual function at 5 years after implantation in patients who were blind from retinitis pigmentosa or outer retinal degeneration, according to a study.

and more »

Ziv-aflibercept may provide another anti-VEGF treatment option
Healio
Ziv-aflibercept may provide another anti-VEGF treatment option. The drug may be a safe, low-cost alternative to treat macular diseases in developing countries and countries that do not have access to aflibercept.


Significant improvements seen with high-power foldable IOL in nanophthalmic eyes
Healio
Measurements of contrast sensitivity and distortion aid surgical decision-making in eyes with macular pucker · FDA approves lifitegrast for dry eye disease · Computer-based image analysis expands diagnostic parameters for ROP · More publications » ...

and more »

Global Vitreous Tamponades Market is Expected to Reach USD 77.5 Million Globally in 2020; Driven by High ...
GlobeNewswire (press release)
Increasing incidence of macular pucker, diabetic retinopathy, and other retinal disorders that require attentive care of the retina during the course of treatment is fueling the vitreous tamponades market. In addition, the increasing number of ...


Nature.com

The kinetics of VEGF and MCP-1 in the second vitrectomy cases with proliferative diabetic retinopathy
Nature.com
Twenty-one eyes of 21 patients who needed a second surgery for PDR were included. The reasons for the second surgery were tractional retinal detachment (TRD), neovascular glaucoma, persistent vitreous hemorrhage, macular pucker, and secondary ...


Daily Mail

Walnuts keeps heart disease at bay through lower cholesterol without weight gain
Daily Mail
A handful of walnuts a day could keep heart disease and other age-related illnesses at bay. Research has shown that regularly snacking on the nuts cuts artery-clogging cholesterol. Walnuts may also cut hunger pangs and reduce the odds of metabolic ...

and more »

Checklists vs. checkmate: Reproducibility key to premium surgery success
Healio
... and total corneal astigmatism; OPD III (Marco) analysis to distinguish corneal vs. lenticular astigmatism, angle kappa magnitude and spherical aberration measurement; OCT analysis of the macula to rule out epiretinal membrane or other macular ...


Combination of high and low add IOLs improve visual acuities, increase patient satisfaction
Healio
NEW ORLEANS — The combination of Tecnis ZKB00 +2.75 and ZMB00 +4.00 multifocal IOLs improved near, intermediate and distance visual acuities and increased overall patient satisfaction, according to a study presented here. “In absence of a real ...

and more »

Pearls and insights from the experts at Moorfields International Glaucoma Symposium, part 2
Healio
Importantly, vision loss due to glaucoma is irreversible unlike other causes of vision loss in uveitis such as cystoid macular edema and cataract. One of the challenges in managing chronic uveitis patients is the objective assessment of active ...


Daily Mail

STATINS found to clear away deposits that cause blindness in the elderly
Daily Mail
An estimated 20 million people worldwide suffer with dry age-related macular degeneration - known as dry AMD - a disease which causes blurred vision and eventually blindness. Known as the 'Alzheimer's of the eye' because of the way it robs elderly ...

and more »

Daily Mail

Genworth Ageing Experience suit mimics life at age 85 with arthritis and more
Daily Mail
Headphones muffle the wearer's hearing while goggles leave them with only peripheral vision due to macular degeneration while the suit's joints were adjusted to simulate the stiffness of rheumatoid arthritis. One volunteer, a 34-year-old named Ugo ...

and more »

Healio

Latest developments in endothelial keratoplasty aimed at graftless surgery, regeneration
Healio
Endothelial keratoplasty has created a revolutionary paradigm shift in the treatment of corneal endothelial disease. Through several iterations the procedure has become increasingly selective, and further developments are now on the horizon.

and more »

Good visualization in retinal surgery can improve outcomes
ModernMedicine
The patient also had a significant macular pucker. After treating the inflammation topically, I thought removing the lens would be a simple case of dialing it into the anterior chamber. I did not anticipate using the endoscope. The lens mobilized ...


Protein targets tissue factor, angiogenesis in CNV related to AMD
Healio
MIAMI — A protein that targets tissue factor in neovascular age-related macular degeneration was well tolerated in a phase 1 study, a speaker told colleagues here. Featured. American Society of Retina Specialists 2016 Meeting · European Glaucoma ...


Speaker considers surgical options for pseudoexfoliation glaucoma
Healio
Postoperatively, patients with pseudoexfoliation are prone to increased inflammation, abnormalities of the blood-aqueous barrier that can result in flare/fibrin, posterior synechiae and macular edema, as well as IOP spikes that should be monitored ...

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Recommended Macular Pucker Reading

Below are links to other helpful sites to read about macular pucker.


Dr. Pautler's Macular Pucker Blog