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Macular pucker/Epiretinal membrane

Also known as macular or retinal wrinkling, this is a very common, age-related condition which is often found incidentally during an eye examination. As we age, the vitreous gel within our eye begins to degenerate (see posterior vitreous detachment). When the vitreous gel finally peels away from the retina, some cells are left behind on the retinal surface. Over time these cells proliferate and form a sheet, or membrane, over the retina, usually in the central area known as the macula. The cells which form these membranes have contractile properties, occasionally leading to distortion or wrinkling of the retinal surface. If significant retinal surface irregularity occurs, vision can become blurred or distorted. In a minority of cases the retina becomes swollen, a condition called cystoid macular edema, possibly causing more significant visual disturbance.

The effects of epiretinal membranes on vision are usually minor, and treatment is generally not indicated. When vision is significantly impacted, treatment may be offered. Medications- either topically applied drops or injections next to or within the eye- may help alleviate swelling associated with macular pucker. However, definitive treatment is surgical. A procedure called a vitrectomy is performed, in which small instruments are introduced into the eye and used to carefully peel the membrane away from the retinal surface, allowing the retina to assume its regular, flat shape. Recovery, with improvement in visual acuity, is usually rapid.

More extensive epiretinal membranes may be associated with specific conditions, such as diabetic retinopathy, uveitis, retinal detachment, or other retinal disease. These membranes more commonly require surgical intervention, and outcomes are more variable.