The eye is filled with a jelly-like substance called vitreous, which helps keep the eye's round structure. For the majority of our life this substance is fairly solid, similar to Jell-O, but as we age, it begins to shrink and become condensed toward the front portion of the eye. As this occurs, it separates from the surface of the retina. In most instances, this occurs with no negative effects. Some may notice floaters, but no significant change in vision. However, in some people, the vitreous may be firmly attached to a part of the retina and as it pulls forward, microscopic damage may occur on the surface of the retina. When this happens, a healing response is initiated by the retina in an attempt to heal the damaged area. Unlike a macular hole, a break in the retina has not occurred, instead just a superficial irritation. A thin layer of cells will develop a "scar" over the irritated area known as a macular pucker.
Generally, the healing response is relatively mild and only results in a very thin layer of cells on the retina that are clear and not produce significant visual disturbances. However, some may experience an overabundance of cell production that causes a thicker, opaque layer of scar tissue to form on the macula's surface.
For most people that have a significant macular pucker, the growth is very slow and eventually stops. Over time, the contraction of the cells will cause a rippled appearance in the scar tissue and ultimately, the retina itself. When this happens, the central vision is affected.
Symptoms
The symptoms for macular pucker are also common to other conditions that affect the retina. They include:
- Distortion to letters and lines when reading
- Decrease in central vision for both distance and near vision
- Blurred vision when watching television
Your ophthalmologist will perform a dilated retinal examination to examine the back of the eye, a fluorescein angiograph to monitor to the flow of fluid in the eye and possible OCT testing to demonstrate the macular pucker on the retina's surface. The information gathered from these tests will allow for an accurate diagnosis and treatment planning.
Treatment
In most instances, treatment is unnecessary because the distortion to vision is so minimal. When vision loss is more apparent however, surgical repair may be necessary. A vitrectomy will be performed to microscopically remove the vitreous gel from the center of the eye. This allows us to closely look for a retinal tear or detachment and prevent a retinal detachment from occurring.
If a tear or break is found, laser treatment will be performed to prevent the leakage of vitreous fluid. Typically, an intraocular gas bubble is not used in this procedure, so no specialized positioning after surgery is required.
The procedure is normally performed using local anesthesia. Some patients are required to stay overnight in the hospital, where others are permitted to return home the same day. A postoperative exam is necessary 24 hours after surgery as well as regular follow-up examinations for the first six weeks after surgery to ensure the overall success of treatment.
The patient will be measured for glasses about 10-12 weeks after surgery, when the eye has had time to heal. A full visual recovery will take up to four months after surgery.
Just like with any surgical procedure, there are risks involved. A small percentage of patients may experience a retinal tear or detachment during the procedure or postoperatively, but are easily repairable. Cataracts are also likely for patients who have not undergone cataract surgery prior to this time. Surgery will be required to remove cataracts and the placement of intraocular lenses will help restore vision.