Macular Pucker

Macular pucker is a transparent membrane that appears on the surface of the retina, which is the nervous layer of the eye. When this membrane appears on the macula, which is the center of the retina, it can affect the quality of vision.

This membrane appears in 5-10% of the general population and mainly in the elderly (over 60) while in 30 – 40% of patients it appears in both eyes.

The main symptoms, if any, are blurry vision accompanied by the distortion of objects that are being observed. When the disease affects the sight in one eye only, it may go unnoticed by the patient as vision impairment in one eye is compensated for by the good vision of the other eye (overlapping visual fields). This is the reason why the problem is discovered either in a random eye examination or when the patient for any reason whatsoever decides to test the eyesight of each eye separately.

In most cases this membrane does not have an obvious etiology (is idiopathic), while less often it may be related to vascular conditions, inflammations, traumas or other conditions.

Vision in idiopathic membranes remains almost the same with a slight decrease in about half of the patients, while in 30-40% of the patients a greater decrease is observed as well as a significant worsening of their symptoms, although vision rarely drops more than 1/10.

Treatment of an idiopathic membrane depends on the symptoms and their duration. In most cases, surgery is performed for patients with vision below 3-4/10. For patients with better vision, the decision to undergo an operation depends on the symptoms and on the extent to which the symptoms affect the patient’s life.

The operation lasts approximately 30 minutes it is performed under local anesthesia and does not require hospitalization. After the operation, the eye needs to remain covered for 24 hours, while the patient must also use eye drops for about 1 month. Vision improves in about 70-80% of patients and over a period of several weeks after surgery. Even though vision improves significantly, in most cases patients should not expect their vision to be perfect.

For secondary (of a known etiology) idiopathic membranes, the treatment is more complex, as it depends mainly on the underlying condition and even though surgical intervention is an option, it is not always the first option.