From the Guidelines
Vitrectomy surgery is the recommended treatment for macular pucker, as it leads to improvement of metamorphopsia and visual acuity in approximately 80% of patients. A macular pucker is a condition where scar tissue forms on the macula, the central part of the retina responsible for detailed central vision. This tissue can contract and wrinkle the macula, distorting central vision. Symptoms include blurry vision, straight lines appearing wavy, difficulty reading small print, and a gray or cloudy area in the center of vision. Many mild cases don't require treatment as they don't significantly affect vision.
Risk Factors and Diagnosis
The condition is most common in people over 50 and can result from aging changes in the vitreous, previous eye surgery, inflammation, trauma, or other eye conditions 1. Regular eye exams are important for early detection, especially for those with risk factors or experiencing visual changes. Spectral-domain optical coherence tomography (SD-OCT) is a highly sensitive and routine methodology used to diagnose and characterize ERM, VMT, and associated retinal changes 1.
Treatment Options
For more severe cases causing visual problems, vitrectomy surgery is often indicated in affected patients who have a decrease in visual acuity, metamorphopsia, double vision, or difficulty using their eyes together. During surgery, both the VMT and ERM must be removed from the retina surface in order to release the traction on the macula 1. No medications can directly treat a macular pucker, but addressing any underlying inflammation may help prevent worsening in some cases.
Recovery and Outcomes
Recovery from vitrectomy surgery typically takes several weeks to months, with vision gradually improving over time. The majority of ERMs will remain relatively stable and do not require therapy, but in patients who have areas of VMT of 1500 μm or less, the incidence of spontaneous release of traction from the macula occurs in approximately 30% to 40% of eyes over a follow-up of 1 to 2 years 1.
From the Research
Definition and Symptoms of Macular Pucker
- Macular pucker, also known as epiretinal membrane, is a condition where a thin layer of tissue forms on the surface of the retina, causing visual distortion and metamorphopsia 2.
- The symptoms of macular pucker include blurred vision, double vision, and distorted vision, which can affect daily activities such as reading and driving 3.
Treatment Options for Macular Pucker
- Vitrectomy, a surgical procedure where the vitreous gel is removed from the eye, is a common treatment for macular pucker 4.
- Membrane peeling, a procedure where the epiretinal membrane is removed from the surface of the retina, can also be performed to improve vision 5.
- Studies have shown that vitrectomy with membrane peeling can improve visual acuity and reduce metamorphopsia in patients with macular pucker 3, 5.
Outcomes and Complications of Macular Pucker Surgery
- The outcomes of macular pucker surgery can vary, with some patients experiencing significant improvement in vision and reduction in metamorphopsia, while others may not experience significant improvement 6.
- Complications of macular pucker surgery can include cataract formation, retinal tears, and retinal detachment 4, 5.
- Patient satisfaction with macular pucker surgery can also vary, with some patients reporting improvement in vision and reduction in symptoms, while others may not be satisfied with the outcome 6.
Factors Affecting Outcomes of Macular Pucker Surgery
- Preoperative visual acuity can affect the outcome of macular pucker surgery, with patients with better preoperative vision tend to have better postoperative vision 5.
- The presence of cystoid macular edema and internal limiting membrane peeling can also affect the outcome of macular pucker surgery, although the evidence is not conclusive 5.
- The duration of symptoms and the severity of metamorphopsia can also affect the outcome of macular pucker surgery, with patients who undergo surgery earlier tend to have better outcomes 3.