What causes a macular pucker?
Most of the eye’s interior is filled with vitreous, a gel-like substance that fills about 80 percent of the eye and helps it maintain a round shape. The vitreous contains millions of fine fibers that are attached to the surface of the retina. As we age, the vitreous slowly shrinks and pulls away from the retinal surface. This is called a vitreous detachment, and is normal. In most cases, there are no adverse effects, except for a small increase in floaters, which are little “cobwebs” or specks that seem to float about in your field of vision
However, sometimes when the vitreous pulls away from the retina, there is microscopic damage to the retina’s surface (Note: This is not a macular hole). When this happens, the retina begins a healing process to the damaged area and forms scar tissue, or an epiretinal membrane, on the surface of the retina. This scar tissue is firmly attached to the retina surface. When the scar tissue contracts, it causes the retina to wrinkle, or pucker, usually without any effect on central vision. However, if the scar tissue has formed over the macula, our sharp, central vision becomes blurred and distorted.
What are the symptoms of Macular Pucker?
With a macular pucker, you may notice that your central vision is blurry or mildly distorted, and straight lines can appear wavy. You may have difficulty seeing fine detail and reading small print. There may be a gray or cloudy area in the center of your vision, or perhaps even a blind spot.
Symptoms of macular pucker range from mild to severe. Usually macular pucker affects one eye, although it may affect the other eye later. Vision loss can vary from none to severe vision loss, although severe vision loss is uncommon. A macular pucker does not affect your side (peripheral) vision.
Is a macular pucker similar to a macular hole?
Although both have similar symptoms - distorted and blurred vision - macular pucker and a macular hole are different conditions. They both result from tugging on the retina from a shrinking vitreous. When the vitreous separates from the retina, usually as part of the aging process, it can cause microscopic damage to the retina. As the retina heals itself, the resulting scar tissue can cause a macular pucker. Rarely, a macular pucker will develop into a macular hole. An eye care professional can readily tell the difference between macular pucker and macular hole.
How is macular pucker diagnosed?
You can't diagnose macular pucker by looking in the mirror since your eye will usually look and feel normal. The diagnosis is made with a thorough retinal examination through a dilated pupil. A fluorescein angiogram may also be performed. Fluorescein angiography is a photographic test, not involving x-rays, in which a colored vegetable dye is injected into an arm vein. A series of photographs are taken as the dye passes through the back of the eye, allowing us to better determine the extent of macular damage.
How is a macular pucker treated?
Treatment for most patients with macular pucker is usually not necessary, since many remain asymptomatic. Surgery should be considered, however, for those people whose distortion, vision loss, and difficulty with depth perception make their daily activities such as reading and driving difficult.
• Vitrectomy surgery: Vitrectomy surgery is done at the hospital under local anesthesia. This advanced microsurgical technique allows us to restore vision by peeling and removing the pucker from the macular surface, allowing the underlying macula to smooth out and function normally. Patients go home immediately following surgery. There is usually minimal to no pain, except for minor irritation from sutures which absorb within a week of surgery.