Macular Pucker

• 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

Management

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

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