Epiretinal Membrane Peeling or Macular Pucker

The symptoms of a macular pucker are: distortion in lines or letters while reading, a decrease in central vision for distance and reading activities, and blurring or distortion of images when looking at television or in the theater.
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A fluorescein angiogram (injection of a dye into the vein, with photographs taken of the back of the eye) may be recommended to evaluate the situation and determine if leakage or swelling of the retina is taking place as a result of the scar tissue being present on the surface of the macula. In most cases, no treatment is recommended for macular pucker. This is due to the fact that the visual distortion and decreased reading and distance vision is minimal in the majority of patients. Although some mild visual problems are noted, these are usually easily adjusted to and pose no limitation on full activity. In some instances, however, the distortion and vision loss may be significant. There may be an inability to perform certain daily tasks such as reading or driving.
It is at this point, that consideration for surgical repair would be entertained. Surgery would also be considered if vision loss is moderate, but there is evidence on the fluorescein angiogram of significant leakage posing a threat to permanent damage to central vision in those individuals. Repair of a macular pucker or epiretinal membrane is accomplished through use of vitreoretinal surgery. Using microsurgical instruments, a procedure known as a vitrectomy, the microscopic removal of vitreous jell from the center of the eye, is performed.
Unlike macular hole surgery, macular pucker surgery does not typically involve the use of an intraocular air bubble. As a result, no specialized positioning in the postoperative period is required. However, in rare instances where retinal tears or detachments occur at the time of surgery, air bubbles and special positioning may be required.
The surgical procedure itself is typically performed under local anesthesia and a patient may remain in the hospital overnight or may be scheduled for ambulatory surgery, able to return home by the end of the day of the surgical procedure itself. A postoperative examination within 24 hours of surgery is required in all cases. Regular follow-up examinations are performed during the first six weeks of recovery, and then at regular intervals after that. Patients typically utilize several eye drops applied to the operated eye over the course of several weeks following the surgical procedure.
Approximately 10-12 weeks after surgery, when the eye has recovered from the surgery and the macula has had a chance to return to a more normal configuration, the patient is measured for glasses. Full visual recovery may not occur for at least 3-4 months following the procedure.