Macular Pucker: Definition, Causes, Symptoms, Diagnosis, and Treatment

By Cristiano Antonino On Jun 12, 2023

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The term macular pucker indicates a pathology that affects the eye, and which in particular leads to various discomforts of the vitreo-retinal interface, i.e. the area in which the vitreous body, which fills the eyeball, comes into contact with the retina and in particular with the macular area

This disease is also referred to as epiretinal membrane or cellophane maculopathy.

The symptoms of macular pucker are many and can vary greatly between people

Usually, however, this pathology makes it difficult to see details, which become less clear.

When you suffer from cellophane maculopathy, you have difficulty performing actions such as reading or driving a car.

However, many patients are asymptomatic in the initial stages and this factor makes the diagnosis more complex.

The causes of macular pucker are different, but certainly one of the most common risk factors on which it is not possible to intervene is the advancement of age.

Most patients suffering from this pathology are over 65 years of age

What is macular pucker?

Specifically, the macular pucker can be defined as a pathological condition of the posterior segment of the eye.

This pathology determines the formation of a membrane on the surface of the macula, specifically a sort of fibrous-scar tissue, which wrinkles causing irregularities in the layers of the macula.

The appearance of this material is caused by an alteration of the vitreous humor, a connective tissue with a gelatinous consistency which is composed of 99% water and fills the posterior segment of the eyeball.

The functions of this part of the eye are many, such as vision, protection and support.

When this membrane that stretches the macular region occurs, then changes in the ability to see clearly occur.

You may therefore have a distorted vision with false perception of lines and inability to focus.

Symptoms of macular pucker

Symptoms of macular pucker may often be undetected in the early stages, or may not be directly related to pathological changes in the macular site.

The most common are:

image distortion. In this case it is common for the patient to have a vision of images, lines and objects that are deformed or of different dimensions compared to the real ones;
monocular double vision;
blurry vision and the inability to see clearly;
if the maculopathy affects the central area of the macula, the patient may have difficulty distinguishing the central part of the image.

Causes

On the causes of macular pucker there are still many studies that try to investigate the nature of this pathology.

Certainly one of the most common reasons for the appearance of symptoms of this disease is aging.

With increasing age, the eye changes and it often happens that the vitreous body tends to withdraw and not interact with the retina.

This phenomenon known as posterior vitreous detachment if it occurs in a traumatic way can cause retinal lacerations and lead to retinal detachment.

Or if there is a pathological adhesion between the vitreous body and the macula, this sort of “film” can form on the macula known precisely as macular pucker.

Age is essentially one of the main causes of many diseases related to the eyes and vision.

Certainly there are other risk factors and causes of macular pucker that can favor the formation of this pathology, not only in older age.

Among these are:

tobacco intake
hypertension
eye disease or trauma
diabetes, especially if not treated properly
inflammatory eye disease (uveitis)

In addition, macular pucker can be a consequence or side effect of cataract surgery, which aims to correct the opacification of the crystalline lens present in the eyeball, between the iris and the vitreous body.

One of the complications of macular pucker is impaired vision

The lowering of visual capacity caused by this pathology can significantly worsen, also leading to great difficulty in performing everyday actions, such as reading.

The distortion of shapes and images, to which this pathology can lead, also makes it difficult to watch television, work or follow a straight path.

Diagnosis

Making a timely diagnosis of macular pucker is crucial to avoid complications such as retinal detachment.

In order to diagnose this pathology, several tests are necessary, the first is certainly a visit to your family doctor.

Thanks to an initial check-up, during which a history of symptoms, drugs taken at the moment or cases in the family will be made, it will then be possible to obtain a specialist visit.

A specialist visit to the ophthalmologist is essential for diagnosing macular pucker.

There are mainly two diagnostic tools:

The first is the fundus examination. This test involves a very simple procedure, which however allows each part of the eyeball to be analyzed specifically, not only the vitreous body but also the retina and the macula. In this way it is possible to obtain very varied information on the state of health of the eye, but also to investigate any symptoms that characterize this pathology. This test involves the application of eye drops that help dilate the pupil, despite this, however, it is a very simple and non-invasive exam.
Another exam, however more specific, can also be the OCT: the Computed Optical Tomography. This test is also not invasive at all and is very reliable for scanning the cornea and retina. In this case, the use of a diagnostic laser free of harmful radiation is foreseen, which scans the layers of the retina. The exam lasts about 10-15 minutes and can be performed even without dilating the patient’s pupil.

If it is suspected that the macular pucker is the consequence of a more complex pathological condition of the eye, fluorescein retinal angiography may also be useful.

In this case, a photographic test is carried out, which is essential for identifying various vascular pathologies of the eye.

In order to do this, fluorescein is injected as a contrast medium, a substance that has the ability to color the path within the blood flow.

This type of exam has a longer duration and is clearly a little more invasive including the use of an intravenous contrast medium.

Treatments

Especially in cases of asymptomatic people or with good residual vision, macular pucker treatments are not required.

In fact, in the event that the patient does not present symptoms and believes he can live with this condition, only monitoring of this condition over time can be prescribed.

If everyday activities, such as driving, reading, and watching television, do not involve difficulty focusing or distinguishing shapes, there is no therapy.

In the case of patients with more severe symptoms or in which the macular pucker determines a significant reduction in visual acuity, surgery is indicated.

Surgical operations for the correction of macular pucker

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The intervention for macular pucker is based on vitrectomy associated with the removal of the epiretinal membrane and the more superficial retinal layer.

This technique involves the removal of the vitreous body and the macular cellophane responsible for the different symptoms.

With vitrectomy as a remedy for macular pucker it is possible to remove part of the vitreous body and the epiretinal membrane, reducing the irregularity and the “shrinking” of the macular region at the base of the visual loss and the annoying symptoms described.

The duration of this operation is usually 1 or 2 hours and can be performed under both local and general anesthesia.

Vision recovery is very gradual and quantifiable up to 9-12 months after surgery.

During this period, the retinal surface progressively re-stretches, improving the vision of details and the sensation of distortion of straight lines.

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