Epiretinal Membrane (Macular Pucker)

What is Epiretinal Membrane (Macular Pucker)?

An epiretinal membrane (ERM), also known as a macular pucker or cellophane maculopathy, is a thin sheet of fibrous tissue that forms on the inner surface of the retina at the macula — the central part responsible for detailed, sharp vision. As the membrane contracts, it can wrinkle or distort the underlying retinal tissue, causing blurred or wavy central vision. Epiretinal membranes are common, particularly in people over 50, and most are mild enough to require no treatment.

Symptoms

• Blurred or hazy central vision
• Metamorphopsia — straight lines appearing wavy or distorted
• Objects appearing larger in one eye than the other (macropsia)
• Difficulty reading small print
• A grey or blurred patch in the central field

Causes

• Idiopathic (most common) — age-related changes following posterior vitreous detachment
• Retinal tear or detachment
• Diabetic retinopathy
• Retinal vein occlusion
• Uveitis (eye inflammation)
• Previous eye surgery

Diagnosis

Optical coherence tomography (OCT) is the key investigation — it provides detailed cross-sectional imaging of the retinal layers and quantifies the degree of retinal distortion. Fundus photography documents the extent of the membrane.

Treatment

Mild ERM with minimal symptoms is observed with regular OCT monitoring. When vision is significantly affected, vitrectomy surgery — a microsurgical procedure to remove the vitreous gel and peel the membrane from the retinal surface — can improve or stabilise vision in the majority of patients.