What You Should Know About Macular Pucker

What is macular pucker?
Macular pucker (also referred to as preretinal fibrosis or cellophane maculopathy) consists of a cellophane-like membrane that grows over and mechanically "puckers" and distorts the macula.

Macular pucker usually occurs following separation of the vitreous from the surface of the retina (posterior vitreous detachment). Macular pucker can also occur following retinal tear or detachment, trauma, various eye inflammatory diseases, or as an isolated finding (idiopathic). It is not usually associated with medical conditions outside the eye.

Normal Macula.		Whitish superior macular pucker distorting the central macula.

OCT scan (top) of normal macula compared to OCT image of an eye with macular pucker (bottom). The top surface of the macula has a thin sheet of tissue that wrinkles and distorts the retina.

 What are the symptoms of macular pucker?
The "puckered" macula causes the central vision to be blurred or distorted.  Patients may be completely asymptomatic, especially when the other eye sees normally. Some may experience progressive vision loss, although the vision will stabilize for most patients within 6 months of the macular pucker developing. 

How is macular pucker diagnosed?
You can't diagnose macular pucker by looking in the mirror since your eye will usually look and feel normal. The diagnosis is made with a thorough retinal examination through a dilated pupil. A fluorescein angiogram may also be performed. Fluorescein angiography is a photographic test, not involving x-rays, in which a colored vegetable dye is injected into an arm vein. A series of photographs are taken as the dye passes through the back of the eye, allowing us to better determine the extent of macular damage.

What treatments are available for macular pucker?

1) Observation. 
Treatment for most patients with macular pucker is usually not necessary, since many remain asymptomatic. Surgery should be considered, however, for those people whose distortion, vision loss, and difficulty with depth perception make their daily activities such as reading and driving difficult.

2) Vitrectomy surgery. 
Vitrectomy surgery is done at the hospital under local anesthesia. This advanced microsurgical technique allows us to restore vision by peeling and removing the pucker from the macular surface, allowing  the underlying macula to smooth out and function normally. Patients go home immediately following surgery. There is usually minimal to no pain, except for minor irritation from sutures which absorb within a week of surgery.

Preoperative macular pucker.		Normal macular appearance 6 weeks after surgery.

Patients usually notice decreased distortion within several weeks to months following vitrectomy. The level of visual acuity also usually improves by about 50% although it may take several years for maximal vision to return.

The major side-effect is a cataract, with many patients requiring cataract surgery within a year or two of vitrectomy. There is about a 1 in 20 chance of recurrent macular pucker, along with a very small chance of secondary retinal detachment or infection.