Macular Pucker

TMacular pucker describes a distortion of the central vision due to a translucent thin membrane on the surface of the macula.  The symptoms could be minimal in most cases but sometimes the membrane could cause significant vision loss.  Because the macula is responsible for central vision patients will often have trouble with visual tasks like reading and driving.

The cause of macular pucker is related to changes that occur in the vitreous gel that fills the inside of the eye.  Often, floaters, a sign that the vitreous is condensing, precedes the development of a macular pucker.  Sometimes trauma, previous laser, surgery, or intraocular bleeding can be the cause of the pucker.  However in many cases a cause cannot be identified. 

Your retinal specialist will often order an OCT (optical coherence tomogram) to help assess the extent of the macular pucker.  This noninvasive test will be used to help determine if surgery or observation would be most reasonable.  Typically surgery is offered if the pucker is causing visual difficulty and the macula has significant distortion on exam and OCT testing.  If there are no symptoms surgery is typically not recommended.

Surgery, should it be necessary, requires a vitrectomy and membrane peel.  A vitrectomy involves careful removal of the vitreous gel and floaters from the inside of the eye.  Once the gel is removed a small instrument is used to peel the membrane from the surface of the retina.  The surgery can be done under local (patient awake but eye numb) or general (completely asleep) anesthesia.  There is typically no pain during the surgery however some eye irritation and rarely discomfort can be experienced during the first few days post operatively.  Very rare vision threatening complications can occur.  Vision typically improves slowly over the first few weeks to months.

Questions Regarding Macular Puckers:

What are some of the ocular complications associated with surgery?

The most common complication is progression of cataract in patients who have a cataract prior to surgery.  This means that some patients will require cataract surgery sooner because of the macular pucker surgery.

What are the restrictions after surgery?

It is recommended that activity and exertions be limited for the first week after surgery.  Every patient is unique so post operative recommendation will vary.

What is the visual prognosis?

Many factors can affect outcome.  Studies have shown that more than two thirds of patients have a significant improvement.  Your retinal specialist can help answer specific questions to help make an informed decision regarding treatment.

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