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by Scholten A
(Cellophane Maculopathy, Macular Pucker, Epi-macular Membrane)

Definition

An epiretinal membrane is a thin layer of scar tissue that forms on the inner surface of the eye. Most do not cause problems. Vision problems or loss can happen if the tissue covers the back of the eye, called the macula. Epiretinal membrane is also called macular pucker.

Causes

The eye is filled with a gel-like substance called vitreous. Eye issues, injury, and aging can cause a decrease in vitreous. When it pulls away from the lining of the eye it can cause damage. The scar tissue is left after the area heals. The scar tissue always shrinks as it heals and can cause a pucker in the eye lining.

Risk Factors

Macular pucker is more common in adults over 50 years old. Other things that may raise the risk are:

  • Torn or detached retina
  • Eye injury
  • Blood vessel problems
  • Diabetes
  • Inflammation in the eye (uveitis)

Symptoms

Macular pucker may affect one or both eyes. Symptoms are often mild and not noticed. Changes in the macula can cause:

  • Blurring
  • Straight lines (such as door frames) appear wavy or distorted
  • Problems seeing details such as faces or words in a book
  • A blind spot in the middle of vision

Diagnosis

The doctor will ask about symptoms and past health. An eye exam will be done.

Images of the eye will be taken with:

  • Optical coherence tomography (OCT) — to look at scar tissue and retina damage
  • Fluorescein angiogram— a dye is used to look for macular damage and possible causes

Treatment

Most macular puckers are mild and do not need treatment. The eye will be checked during appointments to check for changes. Most will remain stable over time.

Surgery may be needed for macular puckers that are causing vision problems. Once removed, the tissue usually does not come back. Most people will have improved vision but it will usually not return to normal.

Prevention

There are no known guidelines for preventing macular pucker.

RESOURCES

American Society of Retina Specialists  https://www.asrs.org  

The Retina Society  https://www.retinasociety.org 

CANADIAN RESOURCES

The Canadian Ophthalmological Society  http://www.cos-sco.ca  

Canadian Retina Society  https://www.crssrc.ca  

References

Diabetic retinopathy. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/diabetic-retinopathy. Accessed June 1, 2021.

Epiretinal membranes. American Society of Retina Specialists website. Available at: https://www.asrs.org/patients/retinal-diseases/19/epiretinal-membranes. Accessed June 1, 2021.

Epiretinal membrane. Retina-Vitreous Surgeons of Central New York website. Available at: https://www.rvscny.com/patient-eduction/conditions-we-treat/epiretinal-membrane. Accessed June 1, 2021.

Macular pucker. Columbia University Department of Ophthalmology website. Available at: https://www.columbiaeye.org/eye-library/macular-pucker. Accessed June 1, 2021.

Morillon C, Le Goff M, et al. Incidence, progression, and risk factors of epiretinal membranes in the elderly. Retina. 2021;41(3):495-504.

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