Macular Pucker
![Opaque membrane obscures the visibility of the macula and drags the paramacular vessels.](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/images/2022-05/macular-pucker.jpeg?itok=WIzLfrQk 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/images/2022-05/macular-pucker.jpeg?itok=Xew7fGoO 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/images/2022-05/macular-pucker.jpeg?itok=slF9-q1y 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/images/2022-05/macular-pucker.jpeg?itok=Rg6sUjjX 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/images/2022-05/macular-pucker.jpeg?itok=FYiVmp49 430w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/images/2022-05/macular-pucker.jpeg?itok=93Q8Bxcs 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/images/2022-05/macular-pucker.jpeg?itok=LdatKQdV 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/images/2022-05/macular-pucker.jpeg?itok=8K5tuxvX 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/images/2022-05/macular-pucker.jpeg?itok=Fwd2_jcv 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/images/2022-05/macular-pucker.jpeg?itok=I7-RMyqc 1280w)
- 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.
![Macular Pucker](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/images/2022-05/macular-pucker-2.jpeg?itok=klz_ZG7f 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/images/2022-05/macular-pucker-2.jpeg?itok=vBVA1p4l 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/images/2022-05/macular-pucker-2.jpeg?itok=B186ZBiC 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/images/2022-05/macular-pucker-2.jpeg?itok=iPEKEShi 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/images/2022-05/macular-pucker-2.jpeg?itok=bjTMa3xP 430w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/images/2022-05/macular-pucker-2.jpeg?itok=cDe0b3RH 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/images/2022-05/macular-pucker-2.jpeg?itok=eDRPzgEv 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/images/2022-05/macular-pucker-2.jpeg?itok=qzA_0tcM 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/images/2022-05/macular-pucker-2.jpeg?itok=qnyRENpl 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/images/2022-05/macular-pucker-2.jpeg?itok=E3gSSlr- 1280w)
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.](https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_200/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=RFmmI3tG 200w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_260/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=C-iyoR06 260w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_320/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=ZkxOTl7R 320w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_400/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=xkKKQ2pX 400w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1600/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=YvHilEoZ 430w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_520/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=ZjPh-aYn 520w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_640/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=IKpepwhH 640w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_800/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=d7P9km4j 800w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1040/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=QVsR_eqf 1040w, https://www.vagelos.columbia.edu/sites/default/files/styles/cola_media_1280/public/media/images/2022-05/macular-pucker-oct-study.jpeg?itok=Y7t__6a- 1280w)