Macular pucker, also known as epiretinal membrane, is a condition affecting the central part of the retina, called the macula. The integrity of the macula is essential for sharp, detailed vision.
When a macular pucker develops, the macula wrinkles or swells due to traction from a thin layer of fibrotic tissue that forms on its surface. This can cause distorted vision: straight lines may appear wavy, and fine details may become blurry or hard to see. Some people also report a grey, cloudy, or blank area in the center of their vision.
The most common form is idiopathic epiretinal membrane. With aging, the vitreous body—the transparent gel that fills the eye—begins to shrink and detach from the retina. This process, known as posterior vitreous detachment, usually occurs without complications. However, in some cases, it leads to cell proliferation forming a fibrotic band over the macula, creating wrinkles or swelling.
Common symptoms include: distorted or wavy central vision, difficulty seeing fine details, gray or empty areas in the central visual field, peripheral vision is usually unaffected.
If symptoms are mild, no treatment is generally needed. The ophthalmologist may suggest monitoring visual distortions at home using a specific test (the Amsler Grid) during follow-up.
If symptoms worsen and start to interfere with daily activities, surgery may be recommended: vitrectomy with epiretinal membrane peeling. In this procedure, the vitreous and fibrotic tissue on the macula is removed, helping to flatten the macula and gradually improve vision. After surgery, vision improves slowly over time, with reduced distortions. In some cases, vision may not fully return to pre-pucker levels, but significant improvement is common.