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

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Vitreous Tamponades Market CAGR of 3.0% for the Forecast Period Between 2017 and 2025
The Global Health News (press release) (blog)
“Steady growth of vitreous tamponades market is witnessed due to increasing incidence of retinal detachments, diabetic retinopathy, macular pucker, and other retinal disorders,” explains the lead author of the study. As per statistics of the American ...

and more »

Vitreous Tamponades Market to Attract a Revenue of US$89.9 mn by the End of 2025
CMFE News (press release) (blog)
“Steady growth of vitreous tamponades market is witnessed due to increasing incidence of retinal detachments, diabetic retinopathy, macular pucker, and other retinal disorders,” explains the lead author of the study. As per statistics of the American ...


Vitrectomy Systems Market to Reflect Impressive Expansion During 2017-2025
ittechherald.com
Based on the product vitrectomy systems are based on products used such as probes, laser systems, phacoemulsifiers systems and others. By indications, the global vitrectomy systems has been segmented into Retinal detachment, macular pucker, diabetic ...


Measurements of contrast sensitivity and distortion aid surgical decision-making in eyes with macular pucker
Healio
Objective measures of contrast sensitivity and visual distortion can be used to assess the impact of macular pucker on visual function, according to a study. “The study was designed to develop quantitative measures of vision in patients with macular ...


Statins to help prevent scar tissue in the eye?
Science Daily
However, statin medication was not found to be associated with a reduced risk of renewed surgery in the other vitreoretinal disease groups involving retinal surgery, such as age-related macular pucker formation, or vitrectomies performed to treat ...

and more »

Hindustan Times

Medication used to lower cholesterol levels may also protect eyes
Hindustan Times
However, statins were not associated with a reduced risk of renewed surgery in the other vitreoretinal disease groups involving retinal surgery, such as age-related macular pucker formation, the researchers noted. For the study, detailed in the journal ...

and more »

ABC Action News

Solar eclipse: Eye damage can show later
ABC Action News
You may start noticing blurry or distorted vision in the center of the eye. In severe cases, you can end up losing vision completely in the middle. If that happens, it means you may have a macular hole or macular pucker. "You would not want to live ...

and more »

AARP News

Serious Eye Condition Being Misdiagnosed?
AARP News
A new JAMA Ophthalmology study found that one in every four cases of age-related macular degeneration (AMD) was missed by trained eye care professionals, a finding that could have serious implications for the growing population of older adults most at ...

and more »

NBCNews.com

Robot Performs First-Ever Surgery Inside Human Eye
NBCNews.com
In a medical first, surgeons have used a robot to operate inside the human eye, greatly improving the accuracy of a delicate surgery to remove fine membrane growth on the retina. Such growth distorts vision and, if left unchecked, can lead to blindness ...

and more »

The Indian Express

Statins may help prevent scar tissue in eyes
The Indian Express
However, statins were not associated with a reduced risk of renewed surgery in the other vitreoretinal disease groups involving retinal surgery, such as age-related macular pucker formation, the researchers noted. For the study, detailed in the journal ...

and more »

GlobeNewswire (press release)

Retinal Surgery Devices Market Expected to Reach USD 2.1 billion by 2021: Zion Market Research
GlobeNewswire (press release)
Various type of retinal surgery devices such as retinal laser equipment, microscopic illumination equipment, vitrectomy packs, vitrectomy machines, surgical instruments and others are used for the treatment of retinal diseases such as macular pucker ...

and more »

Everyday Health (blog)

Dangerous Eye Problems You Should Never Ignore
Everyday Health (blog)
Macular Puckers and Holes. “A macular hole is a small, full-thickness defect in the macula,” Grodin says. “You may notice loss of central vision or blurred or distorted central vision, making it difficult to read or drive. Macular holes most often ...

and more »

Consider operating early for ERM patients with good visual acuity
Healio
Gomes suggested that we should intervene when visual acuity is worse than 20/25, particularly if there is preoperative metamorphopsia and/or significant cystoid macular edema in hopes of achieving better postoperative visual results. Although this ...


PR Web (press release)

Retina Group of New York Sponsors Juvenile Diabetes Research Foundation (JDRF) Woodbury, NY Gala
PR Web (press release)
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macula pucker, macula hole, cataract surgery complications, uveitis, Plaquenil toxicity and second opinions. The group, led by CEO and ...


Medscape

Ropivacaine: Less Pain, Hemorrhage Risk During Vitrectomy
Medscape
... 2% lidocaine (lido+bupi). Indications for the surgery included proliferative diabetic retinopathy, vitreous hemorrhage, retinal detachment, retinal vein occlusion, macular degeneration, idiopathic macular hole, macular pucker, and high myopic ...


Epiretinal membrane: optical coherence tomography-based diagnosis and classification
Dove Medical Press
Herein, we review the pathogenesis, diagnosis, and classification of ERMs and propose an OCT-based ERM classification system. Keywords: macular pucker, cellophane macular reflex, preretinal macular fibrosis, optical coherence tomography, central foveal ...


WFTV Orlando

Saving sight without surgery: Macular holes
WFTV Orlando
BACKGROUND: A macular hole is a small break in the macula, the center of the eye's light-sensitive tissue called the retina. The macula is responsible for providing the central vision we need for seeing fine detail, like reading, or driving. A macular ...


Pamplin Media Group

Macular Regeneration Clinic a success in St. Helens
Pamplin Media Group
It is very comprehensive, therapeutic and enjoyable! The program is appropriate for wet or dry macular degeneration, Stargardt Disease, retinitis pigmentosa, macular pucker (epiretinal membrane) and diabetic retinopathy. Other vision conditions ...


Global Retinal Surgery Devices Market worth $2.1 billion by 2021: Zion Market Research
GlobeNewswire (press release)
Various type of retinal surgery devices such as retinal laser equipment, microscopic illumination equipment, vitrectomy packs, vitrectomy machines, surgical instruments and others are used for the treatment of retinal diseases such as macula pucker ...

and more »

Technology Networks

FDA Approves Gene Therapy for Inherited Blindness
Technology Networks
In the trials, the gene therapy safety profile was consistent with vitrectomy and subretinal injection procedures. Side effects included cataracts, changes in intraocular pressure, changes in macular structure (macular thinning, macular pucker, macular ...
FDA approves novel gene therapy to treat patients with a rare form of inherited vision lossFDA.gov

all 127 news articles »

Business Wire (press release)

Vital Art and Science Announces License Agreement with Genentech for Its mVT® Service
Business Wire (press release)
The mVT® Service is currently commercially available to retina specialists for patients with maculopathy, including dry and wet age-related macular degeneration, diabetic retinopathy, diabetic macular edema, macular pucker, macular hole, retinal vein ...

and more »

Bel Marra Health

Macular hole causes, symptoms, treatments, and difference from macular degeneration
Bel Marra Health
... the retina, creating a hole. Injury or trauma: macular holes can form following blunt force trauma. Diabetes: diabetic eye disease can lead to macular holes. High degree of myopia (nearsightedness). Macular pucker: scar tissues over the macula that ...


BMC Blogs Network (blog)

Exploring the link between thyroid hormones and vision loss
BMC Blogs Network (blog)
Age-related macular degeneration (AMD) is a major cause of vision loss in older people. Here, we speak to Layal Chaker and Robin Peeters, authors of a recent study published in BMC Medicine, about why thyroid function and AMD may be linked, and the ...


Volume 64 Issue 18
UPENN Almanac
Side effects included cataracts, changes in intraocular pressure, changes in macular structure (macular thinning, macular pucker, macular hole), intraocular infection in one patient, and a reduction in visual acuity in one patient. To date, a total of ...


PR Web (press release)

Retina Group of New York Chairman James M. Maisel, MD Chairs Diabetes Epidemiology, Prevention, Care and ...
PR Web (press release)
These commonly include diabetic retinopathy, macular degeneration, retinal vein occlusion, retinal detachment, macular pucker, macula hole, surgery complications, uveitis, Plaquenil toxicity and second opinions. For more information on The Retina Group ...

and more »

Business Wire (press release)

Global Diabetic Eye Disease Devices Market - Latest Developments by Technavio
Business Wire (press release)
Thus, the MI approach is used in many retinal surgeries such as for the treatment of retinal detachment, macular holes, macular puckers, and diabetic maculopathy.” Looking for the latest information on the global diabetic eye disease devices market ...

and more »

PR Web (press release)

Sabah Shah MD, MBA has Joined the Retina Group of New York Specializing in Uveitis and Vitreoretinal Surgery
PR Web (press release)
During her training, Dr. Shah has published numerous papers on anti-VEGF medications including Avastin, Lucentis and Eylea, and procedures that are currently used by retina specialists such as retinal detachment repair and macular pucker surgery.

and more »

Daily Mail

HEALTH: Am I at risk of losing my sight?
Daily Mail
Q I'm 66 and have been diagnosed with age-related macular degeneration (AMD) and am panicking about possibly losing my sight. I've been told to eat rainbow-coloured veggies and fruit, but are there any supplements that will help? A Several readers have ...


UAB News

Debunking digital eyestrain and blue light myths
UAB News
“Lens manufacturers have jumped on the band wagon of harmful blue light and are creating products that they claim will protect your eyes from macular degeneration or other eye diseases,” Gordon said. “Blue light more often causes eye discomfort and ...


News-Medical.net

Retinal Break
News-Medical.net
Retinal breaks may be peripheral or macular. Peripheral breaks include: Operculated breaks where a small piece of retina is so firmly attached to the vitreous fibers that it is pulled right off, covering a small hole. Flap tears, where a U-shaped or ...

and more »
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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