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Macular Pucker Surgery

Surgery for Macular Pucker.  Randall V. Wong, M.D., Retina Specialist, Fairfax, Virginia.Macular pucker surgery (removing an ERM) is my favorite surgery.  It’s elegant and usually involves healthy eyes.  It’s one of the few operations where we can get significant improvement, as long as we operate early enough.

Symptoms of Macular Pucker

Distortion and blurred vision are the two most common symptoms of an epiretinal membrane (ERM) or “macular pucker.”

Patients noticing a change in vision, either blurry, distorted, or both should consider surgery.  There is no other option.

Causes of ERM

An epiretinal membrane forms on the surface of the retina in response to some minor “trauma.”  In my experience, most patients have already had a PVD (posterior vitreous detachment) preceding the development of this proteinaceous membrane.

Sometimes the “trauma” can be cataract surgery.

The “membrane” really isn’t a true membrane.  Instead, it is simply a sheet of protein (a form of Collagen) which has been over produced by specialized cells (fibroblasts) which normally reside on the retina.

What Causes Distortion and Blurry Vision

The membrane contracts and wrinkles the underlying retina (hence the term “pucker”).  This puckering, or wrinkling, causes loss of vision and usually some distortion as the retina has been physically altered.

On the cellular level, the gentle pulling on the retina causes some macular edema which causes the blurred vision.

When You Need a Vitrectomy

I personally disagree that vision must drop below a certain level (e.g. 20/40) to consider surgery.  Noone can ever guarantee complete restoration of vision with ERM surgery, so the sooner you choose to operate, the better.

I prefer to operate as soon as you notice a change in your vision and we agree that ERM surgery is likely to help you.  At the very least, remove the ERM to prevent further vision loss.

An OCT (optical coherence tomography) should be obtained to demonstrate the changes in the macula, but is not absolutely necessary for surgery to be performed.

What Does this Mean?

Most patients with epiretinal membranes (ERM), macular pucker or cellophane maculopathy have healthy eyes.  The vision changes can be stopped and often improved.

The earlier the intervention, in skilled hands, the better the outcome, that is, operate as soon as you notice a change in your vision as no one should make guarantees about return of vision.  My goals for surgery are primarily to stop further vision loss and to give you the chance of improvement (no one should expect complete restoration of vision).

Item last:  There is a subset of ERM/Macular Pucker/Cellophane Maculopathy called vitreomacular adhesions (VMA) or vitreomacular traction (VMT).  Basically these refer to condition where the vitreous is tugging/pulling on the macula causing similar symptoms of ERM.


Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia


A detached retina is potentially blinding. The retina is the light sensitive tissue that lines the inside of the eye. A retinal tear or hole usually leads to a retinal detachment. Floaters can sometimes be the earliest, and only, symptom. Many times there is little warning and a retinal detachment usually occurs without trauma.

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