Synonyms: Epiretinal membrane (ERM), cellophane retinopathy, surface wrinkling retinopathy, pre-retinal membrane, pre-macular fibrosis.

What is a macular pucker?

Macular pucker or ERM is an abnormal scar tissue that forms on the most sensitive part of the retina called macula. The macula provides the sharp, clear, central vision we need for reading, driving and seeing fine detail. This condition is surgically treatable in symptomatic patients with good results.

How is macular pucker formed?

80% of our eye is filled with a gel like substance known as vitreous. The vitreous is formed of millions of fibers, which are attached to the retina. As our age advances, vitreous gradually contracts and gets condensed. As this contraction and condensation of the vitreous progresses, retina is pulled resulting in a microscopic damage to the inner surface of the retina. As a response to this injury on the macula, a healing progress is initiated on the - Drushti Eye & Retina Centre surface of the retina in the macular region. This healing process consists of migration and mobilization of cells, which then spread along the surface of the retina in the form of a scar tissue. This scar tissue, on contraction can result in mechanical wrinkling and distortion of the retina leading to the visual symptoms. In most cases, this scar tissue is thin and self-limiting causing almost nil or very little visual discomfort. But occasionally, the healing response may be severe enough to cause thick and opaque membrane on the macula, thus causing more visual discomfort.

This healing process consists of migration and mobilization of cells, which then spread along the surface of the retina in the form of a scar tissue. This scar tissue, on contraction can result in mechanical wrinkling and distortion of the retina leading to the visual symptoms. In most cases, this scar tissue is thin and self-limiting causing almost nil or very little visual discomfort. But occasionally, the healing response may be severe enough to cause thick and opaque membrane on the macula, thus causing more visual discomfort.

What are the symptoms of macular pucker?

These are mainly related to mechanical distortion and wrinkling of the retina in the macular area.

• Seeing distorted images
• Blurred central vision
• Difficulty in reading or performing tasks, which need sharp details.

How is it diagnosed?

Detailed retinal checkup of your retina with your ophthalmologist helps in making early diagnosis. Fundus Fluorescein Angiography &/or OCT are needed for diagnosis.

What is the treatment of macular pucker?

If the visual symptoms are minimal due to macular pucker, then usually the policy is to observe the eye. However if your complaint is mainly distorted & decreased central vision due to macular pucker, then surgical treatment is required.

A procedure known as vitrectomy along with peeling of the membrane is performed with specialized instruments. This relieves traction on the retina and abnormal scar tissue is also removed. This helps in reducing visual symptoms.

What is post-operative routine?

Usually patient can go home on the same day or one-day hospitalization may be required. Oral tablets and eye drops are prescribed. Regular follow-up is required for 1st six weeks of surgery. After approximately 10- 12 weeks of surgery, when Macula has reasonably healed, refraction is performed and glasses are prescribed. Full visual recovery usually takes 4- 6 months or sometimes more.

What are the complications of the surgery?

The most common complication of vitrectomy surgery is cataract formation, which may result in gradual deterioration of vision. But it can be managed easily with the cataract extraction. Rarely peeling of the membrane may cause retinal holes and retinal detachment, which may require one or more surgery. Usually complications like eye infections are very uncommon.

How much visual improvement can you expect?

Usually one can expect visual improvement by 2-3 lines (50%) if the cause of your reduced vision was mainly due to macular pucker. Rarely, very minimal improvement occurs in the vision. However seeing of distorted images gets better which is often a chief complaint.

Can it recur back?

Rarely, depending on the reactivation of healing process, macular pucker may recur after a period of 1-2 years. Fortunately it is very rare.