Alamo Optometry Blog

April 27, 2014

Macular Pucker

Filed under: Uncategorized — gkblog @ 1:50 pm

(As appeared in Alamo Today, March 2014)

Since I discussed the macula and macular degeneration last month, I decided to tackle another common finding regarding the macula.  A macular pucker or epiretinal membrane, results when scar tissue forms over the macular area of the retina.  This condition usually does not progress to the point where surgical intervention is necessary, but I have had several patients recently who required surgery.              

                An epiretinal membrane usually develops secondary to trauma/surgery to the eye, but more commonly by posterior vitreous detachment.  A posterior vitreous detachment, or PVD, occurs when the viscous gel that is in the back portion of the eye pulls away from the retina and causes a sudden onset of floaters.  This sudden onset of floaters is the usual cause of patients calling the office to schedule an office visit.  A PVD is quite common and is completely benign; however, if this does occur, a dilated examination needs to be done to rule out any retinal tears or detachments.  As the gel contracts away from the macula, it can leave a layer of scar tissue on the surface of the retina.  This membrane that is left is similar to cellophane and over time it can crinkle and tug on the macula causing it to bulge.  The main complaint of a macular pucker from patients is decreased or distorted vision.  Some may notice that images are cloudy or filmy because they are looking through this cellophane-like membrane.   In a percentage of cases, the epiretinal membrane does not contract and the patients’ vision is not affected much.   A macular pucker is diagnosed through a dilated exam and does not require a specialist referral until vision decreases.  If needed, another test called Optical Coherence Tomography (OCT) can take highly sensitive images of the macula to ascertain the exact amount of macular bulging and if there is a macular hole.  However, monitoring is all that is required for most patients.

                In those patients who experience a drop in vision, surgery is required.  When vision becomes compromised, the forces of the membrane on the macula cause severe bulging of the tissue or a macular hole develops.  A macular hole occurs when the membrane contracts so much that part of the macula is not fully attached to the retina.  If surgery is needed, the retinal surgeon will remove the vitreous gel in the posterior portion of the eye and will also remove the membrane.  This surgery is very delicate as it is difficult to remove the thin membrane without damaging any of the retina tissue underneath, which is why surgery is not performed until the drop in vision becomes too symptomatic for the patient.   The procedure is done as outpatient, and depending on the severity of the condition, special head positioning or tilting might be required after the surgery to help the eye heal properly.  Vision improves after surgery, but it generally does not completely return to pre-macular pucker level. 

                As is usually the case, routine eye exams can help diagnose and manage a macular pucker.  If needed, we can refer to a retinal specialist if further testing or surgery is required.

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