Macular Pucker

Opaque membrane obscures the visibility of the macula and drags the paramacular vessels.
  • The formation of thick, coarse, dense membrane which causes marked distortion of the macula that may sometimes elevates the fovea off the pigment epithelium. (puckering the macula)

Clinical Features

  • Symptoms:
    • Markedly decreased vision or loss of central vision
    • Metamorphopsia
    • Diplopia
    • Central photopsia or macropsia
  • Signs:
    • Thick, opaque membrane may obscure the visibility of the macula
    • Foveal ectopia
    • Commonly causes dragging of the paramacular retinal vessels
  • Chronic cases may be complicated with retinal pigment epithelium changes, retinal vascular leakage, macular hole, macular edema, hemorrhage, foveal cyst or choroidal neovascularization.
  • Fluorescein angiogram demonstrates:
    • Dragged perifoveal vessel
    • Dye leakage


vitreoretinal surgery should be considered when significant visual reduction (BCVA of < 20/50) has occurred.

Macular Pucker

A case of macular pucker that demonstrates:

  • Marked striation of the inner retinal layer in the perifoveal area
  • Foveal distortion or ectopia
  • Dragging and increasing tortuosity of the paramacular retinal vessels
OCT study of a macular pucker demonstrating an elevated fovea off the pigment epithelium and a dense epiretinal membrane.