| What
is Macular Pucker?  The
eye is like a tiny camera, with lenses in front and film
in the back. The film in the back of the eye is called the
retina. The center part of the retina, which provides most
of the reading and other sharp, central vision is called
the macula.
The area in front of the retina is normally
filled with a jelly-like material called vitreous. At birth,
the vitreous is quite firm and has thin fibrous strands
running through it and a clear fibrous skin on the back.
As the vitreous ages, it becomes more liquid. Eventually,
the fibrous skin peels partially or totally away from the
retina. This process, called vitreous detachment, increases
the number of floaters but does not usually cause damage
to the retina.
Occasionally the vitreous can cause irritation
to the macula, which can stimulates the formation of a thin
sheet of scar tissue on the macular surface. This looks
like cellophane and is sometimes called “cellophane
maculopathy”. The scar tissue may thicken or contract
over a period of time. This can distort or “pucker”
the macula, causing significant visual distortion. This
condition is called a macular pucker.
How
is Macular Pucker Diagnosed?
Macular
pucker causes fairly typical symptoms, although these symptoms
are sometimes confused with macular degeneration, which
is a totally different condition. It has a very typical
appearance and is usually easy to diagnose with a dilated
eye examination. Sometimes a special computerized picture
test called a fluorescein angiography is performed to rule
out other problems under the scar tissue, and to find inflammation
sometimes associated with the pucker. This involves injection
of a yellow dye into a small arm vein, which is then photographed
as it flows through the circulation in the back of the eye.
There are no X-rays, and the dye is generally very safe,
with serious allergic complications being very unusual.
How
is Macular Pucker Treated?
If the visual change is minor,
and the patient is still able to function comfortably, then
no intervention may be necessary. If the pucker is severe
enough to prevent the patient from seeing and doing what
they would like to, then the scar tissue can be surgically
removed. This involves an operation called a vitrectomy.
Tiny needle-sized openings are made in the white part of
the eye. Tiny instruments, the size of hypodermic needles,
are then used to gently peel the scar tissue away from the
macular surface. The vitreous gel is removed to gain access
to the macula. It is replaced with a clear fluid that the
eye naturally replenishes continuously.
Vitrectomy surgery is usually done as an outpatient. The
experience for the patient is similar to having cataract
surgery. There may be some scratchy feeling on the day after
surgery, but typically there is no severe pain. This surgery
is usually done with a local anesthetic injection behind
the eye. Complications, such as bleeding, infection, and
retinal detachment are very unusual.
Visual recovery may take weeks to months, but the eye will
feel relatively comfortable within days of the surgery.
The patient can usually resume normal activities within
one or two weeks after surgery.
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to the Retina Center
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