Macular Pucker
What is Macular Pucker?
A macular pucker is a membrane that develops at the very center of the macula. Doctors theorize it occurs as cells grow on the surface of the macula and then pull on the retina. The membrane causes wrinkles (a “pucker”) in the central macula. Early in the development of a macular pucker there is little disturbance of vision. As the central macula is distorted vision is reduced. The macula may also swell as the pucker pulls on the normal blood vessels causing them to leak. Severe leakage can cause cysts in the retina; a severe problem called “cystoid macular edema.”
Who develops macular pucker?
Macular membranes are common and can be found in nearly 20% of patients in their 70’s. It can be found in younger patients with trauma, diabetics or patients with inflammatory disorders. Macular membranes causing a “pucker” are much less common.
Grades of macular pucker
There are 3 grades of macular pucker. Grade 0 is an occult pucker and usually has no symptoms. It is also referred to as “Cellophane Maculopathy” because of its appearance similar to cellophane lying on the macula. Grade 1 is a minor wrinkling without symptoms or reduced vision. Grade 2 is wrinkling of the macula with symptoms and reduced vision.
Treatment for macular pucker
Past research has shown that surgery, a vitrectomy is beneficial for Grade 2 macular pucker, but not for early Grade 0 or 1 pucker. Vitrectomy is performed under local anesthesia as outpatient surgery. The surgery takes less than an hour to complete. The vitreous is removed with a miniature hand-held cutting device and replaced with a special solution similar to the vitreous. The vitreous and the membrane are removed from the retina under a microscope. In certain cases an injection of steroid onto the retina is required to help treat retinal swelling. The success of the surgery in terms of improvement of vision is not known until 2 to 3 months after surgery. Most patients’ vision continues to improve for up to 1 to 2 years after the surgery. The surgery can cause retinal detachment, glaucoma, cataracts, droopy eyelids and injury to the optic nerve. Very rarely, a gas bubble may be required to repair any retinal tear or detachment. Gas is used to fill the eye and push the retina in place during the healing phase. The doctor may require you to position your head for as much as possible for 1 to 2 weeks to allow this healing to be successful. The body absorbs this gas bubble over several weeks to months. Vision is poor for the first 6 to 8 weeks after surgery until at least 50% of the gas is absorbed.