Macular Pucker


Macular Pucker

Description, Causes and Risk Factors:

Macular pucker is a thin sheet of fibrous tissue that can develop on the surface of the macular area of the retina and cause a disturbance in vision. The retina is a clear film of very delicate tissue that lines the inside of the back of the eye. The macula is in the center of the retina and it gives us sharp central vision and reading vision.

Macular pucker develops as a result of cellular changes that occur in the back of the eye between the clear vitreous gel that is normally present, and the macula. Normal biological cells derived from the retina and other tissues within the eye become liberated into the vitreous gel and eventually settle onto the surface of the macula. These cells may begin to proliferate into a “membrane.” In many instances this membrane remains very mild and does not have any significant effect on the macula or the person's vision. In other cases, however, the membrane may slowly become more prominent, eventually creating a disturbance in the retina that leads to visual blurring and/or distortion in the affected eye.

In the majority of cases, an epiretinal membrane develops in an eye with no history of previous problems. This type of epiretinal membrane is called idiopathic. Occasionally however, an epiretinal membrane will develop in an eye as a result of retinal detachment, trauma, inflammatory disease, blood vessel abnormalities, or other pathological conditions. Most epiretinal membranes are mild and have little or no effect on vision. However, in some cases, the epiretinal membrane may slowly grow and begin to cause mechanical distortion (“wrinkling”) in the macula. This may lead to blurred or distorted vision, which may slowly worsen over time. An epiretinal membrane does not make an eye go completely blind. It typically affects only the center area of vision and does not cause a loss of the peripheral (side) vision.

Other eye conditions associated with macular pucker include:

    Vitreous detachment.

  • Torn or detached retina.

  • Inflammation (swelling) inside the eye.

  • Severe trauma to the eye (from surgery or injury).

  • Disorders of the blood vessels in the retina, such as diabetic retinopathy.

Symptoms:

Symptoms of macular pucker range from mild to severe. Usually macular pucker affects one eye, although it may affect the other eye later. Vision loss can vary from none to severe vision loss, although severe vision loss is uncommon. A macular pucker does not affect your side (peripheral) vision.For most people with macular pucker, their vision remains stable and does not worsen over time.

Diagnosis:

During an eye exam, your ophthalmologist will dilate your pupils and examine your retina. You may have a test called fluorescein angiography that uses dye to illuminate areas of the retina.Another test called optical coherence tomography (OCT) is helpful in making an accurate macular pucker diagnosis. With OCT, a special camera is used to scan your retina. It measures the thickness of the retina and is also very sensitive at detecting swelling and fluid. OCT can also diagnose macular abnormalities that are too small to be seen in an examination or with angiography.

Treatment:

There is no good evidence for any preventative actions, since it appears this is a natural response to aging changes in the vitreous. Posterior vitreous detachment (PVD) has been estimated to occur in over 75 per cent of the population over age 65, that PVD is essentially a harmless condition (although with some disturbing symptoms), and that it does not normally threaten sight. However, since epiretinal membrane appears to be a protective response to PVD, where inflammation, exudative fluid, and scar tissue is formed, it is possible that NSAIDs may reduce the inflammation response. Usually there are flashing light experiences and the emergence of floaters in the eye that herald changes in the vitreous before the epiretinal membrane forms.

Surgical Options: Surgeons can remove or peel the membrane through the sclera and improve vision by 2 or more Snellen lines. Usually the vitreous is replaced at the same time with clear fluid, in a vitrectomy. Surgery is not usually recommended unless the distortions are severe enough to interfere with daily living, since there are the usual hazards of surgery, infections, and a possibility of retinal detachment. More common complications are high intraocular pressure, bleeding in the eye, and cataracts, which are the most frequent complication of vitrectomy surgery. Many patients will develop a cataract within the first few years after surgery. In fact, the visual distortions and diplopia created by cataracts may sometimes be confused with epiretinal membrane.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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