A macular pucker is a scar tissue that forms on the macula. The tissue causes wrinkles and bulges on the surface of the retina.
The macula is situated at the centre of the retina. It contains photoreceptors which convert light into signals. The signals are interpreted by the brain as images which one sees. A healthy macula lies flat against the back of the eye. It is tasked with perceiving fine details and color. When damaged, the central vision is distorted.
Also Known As
- Cellophane maculopathy
- Epiretinal membrane
- Retinal wrinkle
- Premacular fibrosis
- Internal limiting membrane disease
Causes and Risk Factors
A macular pucker develops due to the detachment of the vitreous humor from the retina. This is a normal aging process that occurs as the vitreous humor shrinks and changes in shape. It is usually a harmless process that may only result in floaters.
However, in some instances, the detachment can cause some damage to the surface of the retina. As the area begins to heal, the scar tissue/epiretinal membrane begins to form. The contraction of the tissue causes the retina to wrinkle. When the scar forms on the macula, problems in the central vision arise.
Other causes of macular pucker can include retinal detachment, uveitis, trauma or diabetic retinopathy. The risk factors for the condition are old age and the female gender.
Signs & Symptoms
Patients with macular pucker experience blurred vision. Usually, straight lines will appear wavy. It also becomes difficult to read, drive or do other activities. There may also be blank spaces in central vision with time.
Diagnosis for macular pucker may include the following:
- Visual acuity test – This is done to assess the clarity of vision of the eye.
- Dilated eye exam – Involves the use of dilator drops to allow proper viewing inside the eye.
- Imaging tests – Optical coherence tomography (OCT) and fluorescein angiography are used for diagnosis. In OCT, a machine scans the back of the eye. In the latter, fluorescein dye is injected into the bloodstream of the eye to highlight the vessels when photographed. Both tests assess the condition of the macula.
- Tonometry – In a few instances, the intraocular pressure (IOP) may also be measured.
Treatment for macular pucker is focused on improving vision.
In most cases, no treatment is required. Majority of people learn to live with the mild visual distortion. Other times, the scar tissue may separate from the retinal surface and the condition resolves on its own.
Where the condition is severe, patients can opt for a vitrectomy. The surgery involves removal of the vitreous gel to prevent the pull that causes damage. The epiretinal membrane/scar tissue is also removed. The operation is performed under local anesthesia while the patient is awake.
After the surgery, the eye surgeon will administer antibiotic eye drops to prevent infection. Follow up should be done as frequently as possible to monitor the progress.
The patient may be required to wear an eye patch for as long as the doctor recommends. The patch protects the eye from infection as well as irritants. It also prevents the patient from rubbing the eye.
Despite the surgery being very delicate, it is useful in improving vision. After the operation, recovery can take up to three months. In about half the cases, vision is properly restored. In a few instances, the macular pucker may grow back. Complications related to the surgery may also arise in some individuals. Some of these include:
- Retinal detachment – This is a condition where the retina is pulled from the back, moving away from its position. It is responsible for severe visual impairments and should be treated immediately.
- Cataract development – The usually clear lens may also get clouded after the vitrectomy. This clouding develops rapidly and could lead to blindness. The cataract can be removed through surgery.
Visiting an eye doctor regularly is important to detect any eye problems early and prevent complications.