Macular Pucker

A jelly-like substance called the vitreous fills the central portion of the eye.  For the majority of our life, this substance is fairly solid and homogeneous, similar to Jell-O.  As we age, it begins to shrink and condense toward the front portion of the eye with clear fluid filling the space freed up by the vitreous.  As this occurs, the vitreous gradually separates from the surface of the retina.  However, in some people, the vitreous may be firmly attached to a part of the retina and as it pulls away, 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 repair the damaged area.  Unlike a macular hole, a break in the retina has not occurred, but instead a superficial irritation.  A thin layer of cells develops 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 do not produce significant visual disturbances.  However, some patients experience develop an opaque layer of scar tissue 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 coniditions that affect the retina.  They include:

  • Distortion to letters and lines when reading
  • Decrease in central vision for both distance and near vision

Diagnostic Testing

Your ophthalmologist will perform a dilated retinal examination to examine the back of the eye.  We may also use a fluorescein angiogram to monitor the retinal blood circulation to ensure there are no other conditions present.  OCT testing can 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 many instances, treatment is unnecessary because the distortion to vision is minimal.  When vision loss is more pronounced, however, surgical repair may be necessary.  Minimally invasive, microincisional vitrectomy surgery allows the retinal surgeon to remove the vitreous gel through tiny incisions in the white part of the eye and thus relieve the traction on the retina.  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 and monitored sedation.  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 after the eye has had time to heal.  A full visual recovery will take several months.

As with all surgical procedures, there are certain risks and possible side effects.  These risks include possible retinal tears or detachment during the surgery or in the postoperative period.  These complications, however, are usually repairable.

In addition, patients will likely develop cataracts within six months to two years after surgery, unless they have already undergone cataract surgery.  When this occurs, ambulatory surgery is required to remove the cataracts and the placement of intraocular lenses is necessary.