Macular Pucker

How the eye functions

The structure of the eye is similar to the camera with lenses in front and film in the back.  The film, which lines the back of the eye is called the retina.  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.  This can be compared to gelatin that has been removed from the refrigerator and put in a warm room, becoming more liquid as it is left to stand.  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 cause damage to the retina.

What Is Macular Pucker?

The retinal surface can form a thin sheet of scar tissue which can distort the vision. Occasionally, the retinal surface can form a thin sheet of scar tissue over the macula (the reading portion of the retina) which can distort the vision.  This distortion is called macular pucker.  In order to study the distortion of the retina caused by puckering, a fluorescein angiogram is done.  This photographic test provides useful information about distortion, damage and swelling that has resulted from the macular pucker.  If the pucker is severe enough to cause visual problems, scar tissue may be surgically removed.  This operation is called a vitrectomy and includes the delicate peeling of the abnormal tissues from the retinal surface as well as removal of the central vitreous from the eye.  The vitreous is then replaced with a clear fluid.

What are the symptoms of a Macular Pucker?

The macula needs to lie flat against the back of your eye to work properly. When it develops wrinkles, creases, or bulges, that’s a macular pucker. You’ll know if this has happened because your central vision will be affected. In your central vision, straight lines will appear wavy. It could be difficult seeing detail. You could notice a grey or cloudy area in your central vision, almost as if you’re seeing that section through a shadow. Sometimes a macular pucker can create a blank spot in the central vision. Peripheral vision will not be impacted. 

What causes a Macular Pucker?

Normal aging is the most common cause of a macular pucker. This is because as we get older, our vitreous that fills our eyes become less gel-like and more liquid. This can cause it to pull away from the retina in spots. For most people, this happens without incident. There may be a few flashes, but no permanent issue. But sometimes when this pulls away the vitreous can stick to the retina. When it finally dislodges, it leaves behind scar tissue from the strain, and this causes the wrinkle, crease, or bulge that is a macular pucker. 

Who is at risk of developing a Macular Pucker?

Most cases of developing a macular pucker are simply due to aging. That’s because the vitreous becomes less gel-like and that’s when it pulls away from the retina. Certain other eye problems can raise a person’s chances of developing a macular pucker. They are:

• Posterior vitreous detachment

• A torn or detached retina

• Swelling inside the eye

• Previous surgery or serious damage to the eye from injury

• Problems with blood vessels in the retina

Macular Pucker treatment

If your macular pucker isn’t causing significant issues with your vision, we may recommend leaving it as is. In those cases, we would then want to see you for eye exams more frequently to make sure the epiretinal membranes involved don’t change or start causing problems. We may make adjustments to your eyeglass or contact lens prescription to improve your vision. You may need bifocals for up-close vision.

If the problem with these membranes is impacting your vision, however, surgery is necessary to remove the scar tissue. The procedure is known as a vitrectomy. 

After sedating you and applying local anesthesia, we make three small incisions in the sclera, the white of your eye. Through one incision, we insert a microscope with light to allow us to see inside your eye. Through another incision, we insert forceps to peel the scar tissue off the retina. We will insert a silicone-tipped drainage needle or needles to remove the vitreous from the eye. We may insert a laser probe to seal any retinal tears or treat abnormal blood vessels in the eye. Next, we remove the vitreous from the eye. Then the scar tissue is peeled off of the retina. If you have a tear in the retina it will be repaired. If the retina is pulling away from the back of the eye, we will return it to its proper position. We then replace the vitreous with a sterile saline solution. The final step is to place an air or gas bubble in your eye that will help the retina adhere to its proper position again. 

What happens if I leave a Macular Pucker untreated?

If you have only minor vision issues caused by the scar tissue on your retina, you may be able to simply change your eyeglass prescription or maybe add a magnifier for reading and other close-up tasks. If your vitreous stabilizes and doesn’t tug on the retina any additional amount, your macular pucker will remain the same. 

But if your central vision now has a grey area or a blind spot, or if you’ve lost the ability to see detail, such as fine straight lines, this isn’t something to live with. Our experienced ophthalmologists at The Eye Care Institute can remove the scar tissue and improve the problems with your vision. 

Is Macular Pucker surgery painful?

During the surgery, you won’t feel anything. These are not painful recoveries. 

What are the potential risks or complications with surgery for a Macular Pucker?

These are safe, effective procedures when done with the experienced team at The Eye Care Institute. However, this is surgery so there is some risk. Risks for these procedures include:

• Eye infection

• Bleeding in the eye

• A detached retina

• Having a recurrence of a macular pucker

• Cataract development

Schedule your consultation today

If you're interested in learning more about macular pucker please contact us for a consultation at (502)589-1500 or fill out our contact form. We will discuss your needs and concerns, and determine your best course of action.