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A macular pucker, also called an epiretinal membrane, is a sheet of scar tissue that grows over the macula, the central part of the retina. A macular pucker wrinkles, like cellophane, and this wrinkling causes the macula beneath it to also wrinkle, becoming swollen and distorted. Macular puckers can cause macular edema, or swelling, which results in blurred, wavy or distorted vision without pain. If we think of the eye as a camera and the macula is the film in the camera, then having a macular pucker is like taking a picture with wrinkled, warped film.
If a macular pucker is mild, it may stay stable for years or it may gradually worsen, causing more visual distortion and vision loss. The treatment for a macular pucker is vitrectomy surgery with peeling of the flat sheet of scar tissue from the macula. Then, over time, the wrinkling and swelling in the macula is able to resolve.
Surgery is usually only recommended when there is at least moderate vision loss or when there is significant visual distortion that interferes with daily activities such as reading or driving.
