Macular Pucker | A Guide to Causes and Treatments | Ophthalmology

Macular Pucker

What is a macular pucker?

The eye is often compared to a camera. The front of the eye has a lens that focuses images on the back of the eye. This area, called the retina, is covered by specialized nerve cells that respond to light. These nerve cells are located very close to the centre of the retina, where the eye focuses on the images we see. This small part of the retina is called the macula.

The macula is usually flat on the inner posterior surface of the eye. Sometimes cells can shrink inside the eye and pull on the macula. Occasionally, an injury or medical condition creates fibres of scar tissue within the eye. These are called the epithelial membrane and can pull on the macula and cause a distortion of vision. When this pulls on the macula wrinkles, it is called macular pucker. In some eyes, it has less effect on vision, but in others, it can cause significantly distorted vision.

Macular pucker (also known as epithelial membrane) is an eye condition that affects the central retina or the macula. As the name suggests, it is caused by distortion or “compression” of the macula. This condition is sometimes called “cellophane maculopathy” because it is caused by a thin, transparent layer of cellophane-like scar tissue on neurons in the macula.

Although macular frown is a different disease than age-related macular degeneration, both diseases have similar characteristics such as wavy or distorted vision in the middle of the visual field. Macular pucker usually causes only a slight distortion of vision in one eye; However, less often it affects both eyes and significantly loses central vision.

Scar tissue grows through an injury to the eye. The most common type of “injury” is the separation of the jelly (vitreous) in the middle of the eye from the retina, which occurs in most people during the aging process. The vitreous is made up of water and a network of tiny fibres. When these fibres separate from the retina, they pull on the retina and cause enough damage to stimulate the growth of scar tissue. Alternatively, the growth of scar tissue can be induced by inflammation, trauma, and possibly, in rare cases, cataract surgery to the eye.

What causes macular pucker?

Much of the inside of the eye is covered with a gel-like vitreous substance that helps the eye maintain a rounded shape. As we age, the vitreous slowly contracts and moves away from the surface of the retina. This is called a vitreous detachment. It is normal and causes no symptoms. Some people may have a small increase in floaters that are less “cobwebs” or spectra that appear to float in the field of view, but this is generally not harmful.

But sometimes the vitreous retina is damaged when it is pulled. (It doesn’t look like a macular hole.) When this happens, the retina begins the healing process of the damaged area and forms scar tissue, called “epithelial membrane.” This scar tissue sticks firmly to the surface of the retina. When it shrinks, it can cause wrinkles or wrinkles on the retina. It generally does not harm the central vision. However, if scar tissue forms on the part of the retina that supports the macula, acute central vision becomes blurry and distorted.

Most macular pus is related to aging, but it can also be caused by other eye conditions. These include isolated retina, uveitis, and diabetic retinopathy. A macular pucker can occur due to injury from eye surgery or an eye injury.

What are the symptoms of macular pucker?

The main feature of the macular pucker is a changed in vision. Vision changes and damage range from none to severe. But severe vision loss is rare.

People with macular frown may notice that their vision is blurry or slightly distorted and straight lines with rings appear. They may find it difficult to see fine details and read the fine print. They may also have a grey area or blind spot in the centre of vision.

Is macular pus equal to age-related macular degeneration?

No! Macular wrinkling and age-related macular degeneration are two different conditions, but the symptoms are the same. Both conditions are called “macular” because they have a “macular” area on the retina. Talk to your eye doctor if you think you have any of these conditions.

Will macular pucker get worse?

For most people with macular degeneration, vision worsens over time, but it doesn’t happen quickly. Macular pucker usually affects one eye first, but then affects the other eye.

Is a macular pucker similar to a macular hole?

A macular pucker and a macular hole are different conditions, but both can occur due to the vitreous pulling away from the retina. When pulling only causes minor damage, the retinal scar tissue heals on its own. This is the macular pucker. If severe damage occurs when pulling, the retina in the macular region will tear and a hole will be created. This is the macular hole. Macular pucker does not turn into a macular hole.

Both conditions cause blurred and distorted vision, but the macular cavity causes more permanent vision loss than macular pucker. If you think you have any of these conditions, talk to your eye doctor.

Diagnosis and monitoring of the Macular pucker

An ophthalmologist who examines the retina after a student dilates the drops can diagnose macular degeneration. By measuring visual acuity, your progress over time can be tracked by looking at a graph called an Amsler grid or by checking for distorted vision through special photographs. These include colour photographs of the retina and important cross-sectional photographs of the retina taken using a procedure called optical coherence tomography (OCT). OCT shows the extent of retinal scar formation and retinal distortion due to traction of scar tissue.

Treatment: Non-surgical intervention macular pucker

Since most patients have only mild symptoms, they can best benefit from new glasses, reading lamps, and perhaps magnifying glasses. For patients with more severe symptoms, medical or surgical treatment may be appropriate. A subset of patients with macular pus caused by a vitreous pull on the macula (in vitro macular traction) may benefit from a single injection into the eye of an active drug called jetrea. This drug is an enzyme that digests small fibres in the vitreous, releasing traction.

Treatment: macular pucker surgery to remove scar tissue

For patients who do not benefit from jetrea, surgery can help. Surgery is performed on the patient under local anaesthesia and the vitreous is removed (vitrectomy) and the cellophane-like scar tissue is usually rubbed off. Helps relieve retinal traction, reduces vision distortion, and improves visual acuity.

Related disorders

The related disease is the macular hole, which is caused by traction on the retina and requires vitrectomy surgery to relieve the traction and close the hole. Another disease called retinal detachment occurs, usually, the retina separates from the back of the eye, usually caused by a tear in the peripheral retina that causes a vitreous pull on the retina during retinal detachment. Symptoms of a retinal tear/detachment in one eye:

  • Bright light curves in peripheral vision;
  • New floating black dots insight; OR
  • A curtain that blocks peripheral vision, which can be expanded to block the central vision.

Since retinal detachment is an emergency, patients with symptoms of retinal detachment should call their ophthalmologist immediately for vision protection treatment if an eye detachment or detachment is diagnosed.

What are the benefits and risks of surgery?

In most cases, surgery for macular pucker can improve vision but does not bring it back to normal. Most people are able to regain about half of the vision they lost from a macular pucker. Some people have much more vision restored, some less. In most cases, surgery can help with vision distortion. Vision recovery can continue for as long as three months after surgery.

The most common complication of a vitrectomy is an increase in how quickly cataracts develop. You might need surgery for cataracts within a year or two after the vitrectomy. Less common complications include retinal detachment either during or after surgery, and infection after surgery. Also, the macular pucker can grow back, but this is rare. Talk to your eye doctor about whether surgery is a good option for you.

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