Vitreous in the pathobiology of macular pucker

Abstract

First described in 1865 by Iwanoff [1], macular pucker has been extensively studied and researched under a variety of names, including cellophane maculopathy, epiretinal membrane, preretinal fibrosis, epiretinal fibrosis, and surface wrinkling retinopathy [2, 3]. Macular pucker can be defined as a premacular, avascular, fibrocellular membrane with folds and striae in the underlying inner retina and disturbed cytoarchitecture in the outer retina [4, 5]. The term “epiretinal membrane (ERM)” is most often employed, although it is not as accurate as the term “premacular membrane (PMM).” One reason why PMM is more accurate is that the membrane is always anterior to the retina, while the term “epiretinal” means adjacent to the retina and can refer to subretinal membranes. Further, the membrane is only clinically relevant when attached to the macula. Thus, the preferred terminologies are “premacular membrane (PMM)” to refer to the pathologic membrane itself and “macular pucker (MP)” to refer to the effects of this membrane on the macula. This chapter will review the prevailing theories of pathophysiology and the mechanism(s) of visual impairment caused by macular pucker.