MACULA PUCKER
What is a Macula Pucker / Epiretinal Membrane?
An epiretinal membrane, also called a macula pucker, is a thin layer of scar-like tissue that forms on the surface of the retina, over the macula (the central part of the retina responsible for sharp vision).
As this membrane gradually contracts, it pulls and wrinkles the underlying retina, similar to the way a piece of plastic wrap creates folds when stretched over a surface.
This wrinkling distorts the normally smooth surface of the macula, which can cause straight lines to appear bent, wavy, or crooked, and can blur or reduce central vision. Epiretinal membranes are distinct from macula holes, where a break forms through the retina rather than a membrane forming on its surface, though the two conditions share some risk factors and can occasionally occur together. For more on this, see our Macula Hole page.
Macula Pucker / Epiretinal Membrane
Symptoms of Epiretinal Membrane
Symptoms vary widely depending on the severity of the membrane and how much it distorts the macula:
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Mild cases may cause no symptoms at all and are sometimes discovered incidentally during a routine eye examination
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Distorted vision, where straight lines (such as door frames, window blinds, or text) appear wavy, bent, or crooked (a symptom known as metamorphopsia)
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Blurred central vision
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Difficulty reading, particularly with smaller text
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A sense that one eye's vision is different in clarity or shape compared to the other
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In more advanced cases, double vision in one eye can occur due to the distortion of the retinal layers
Symptoms typically affect one eye, though epiretinal membranes can occur in both eyes over time.
What Causes an Epiretinal Membrane?
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Age-related vitreous changes (most common): as the vitreous gel separates from the retina with age (posterior vitreous detachment), it can leave behind cells on the retinal surface that proliferate and form a membrane
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Previous retinal conditions: a history of retinal tears, retinal detachment, or previous retinal surgery can increase the likelihood of membrane formation
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Diabetic eye disease and retinal vein occlusion: inflammation or abnormal blood vessels associated with these conditions can contribute to membrane formation
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Eye inflammation (uveitis)
Most epiretinal membranes are idiopathic, meaning they occur as part of the normal ageing process without an identifiable underlying disease.
Does an Epiretinal Membrane Always Need Surgery?
Not necessarily. Unlike a full-thickness macula hole or a retinal detachment, an epiretinal membrane is often a slowly progressive condition, and many people with mild membranes have minimal symptoms and stable vision for years without requiring surgery.
The decision to proceed with surgery is generally based on:
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The degree of visual distortion or blurring, and how much it affects daily activities such as reading or driving
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Whether vision has been getting progressively worse
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The appearance of the membrane on OCT imaging, including the degree of retinal thickening or structural change
For membranes causing minimal symptoms, observation with periodic monitoring is often appropriate, with surgery considered if symptoms progress. This is an important discussion to have with your retina specialist, as surgery carries its own risks and is generally reserved for membranes significantly affecting vision or quality of life.
​How is an Epiretinal Membrane Diagnosed?
Diagnosis is made through a clinical examination combined with optical coherence tomography (OCT), which provides a detailed cross-sectional view of the retina. OCT allows the membrane to be visualised directly, shows its effect on the underlying retinal structure, and can be used to track changes over time if observation is chosen initially.
Epiretinal Membrane Surgery: Vitrectomy and Membrane Peeling
When surgery is appropriate, the standard treatment is vitrectomy with membrane peeling, which typically involves:
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Vitrectomy: the vitreous gel is removed from the eye.
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Staining: a special dye (such as a blue stain) is used to enhance visualisation of the thin, often near-transparent epiretinal membrane against the retina.
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Membrane peeling: the membrane is carefully and gently peeled away from the surface of the retina using fine surgical instruments, releasing the wrinkling and allowing the macula to gradually flatten and recover its more normal contour.
In some cases, the internal limiting membrane (ILM), a deeper layer beneath the epiretinal membrane, may also be peeled to reduce the risk of the membrane reforming (recurrence).
RecoveryAfter Surgery
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Most patients return home on the same day as surgery
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Vision is often blurred initially and improves gradually over weeks to months as the retina settles
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Distortion of straight lines (metamorphopsia) often improves significantly after surgery, though it may not always resolve completely, particularly if the membrane was present for a long time before surgery
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Unlike macula hole surgery, a gas bubble is not always required, so face-down positioning is not always necessary, though this depends on the specific case
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Regular follow-up visits, including OCT imaging, are used to monitor healing and check for any recurrence of the membrane
FAQ
Frequently Asked Questions
