The eye is often compared to a camera. The front of the eye contains a lens that focuses images on the inside of the back of the eye. This area, called the retina, is covered with special nerve cells that react to light. These nerve cells are very close together in the middle of the retina where the eye focuses the images that we see. This small part of the retina is called the macula.
The macula normally lies flat against the inside back surface of the eye. Sometimes cells can grow on the inside of the eye contracting and pulling on the macula. Occasionally, an injury or medical condition creates strands of scar tissue inside the eye. These are called epiretinal membranes, and they can pull on the macula, leading to a distortion in vision.
When this pulling makes the macula wrinkle, it is called macular pucker. In some eyes, this will have little effect on vision, but in others it can be significant leading to distorted vision.
Sometimes macular pucker is the result of an injury or a medical condition, such as diabetes, that affects the eye. Epiretinal membranes can sometimes form after eye surgery, including cataract surgery. The cause of most cases of macular pucker is not known. Unfortunately, it just seems to happen.
It is not unusual for someone to have epiretinal membranes and still have normal vision. The membranes tend to change with time, however, and the following symptoms can appear:
When these symptoms are caused by macular pucker, they will sometimes affect both eyes, but are usually worse in one eye.
If any of these symptoms occur, it is important to make an appointment with your eye doctor as soon as possible. The doctor will use a special instrument to look inside your eye for epiretinal membranes. Your doctor may also use special imaging devices, including optical coherence tomography, to evaluate the epiretinal membrane.
The doctor might recommend not treating macular pucker if it does not cause significant problems with vision. Instead, he or she might just recommend that the patient have eye examinations more frequently than usual to make sure that the epiretinal membranes do not change and cause problems. More troublesome macular pucker can be treated with surgery.
The operation for macular pucker is usually performed under local anesthetic so the patient is awake but does not feel the procedure.
The first part of the operation for macular pucker treatment is to remove the gel-like material that fills the back of the eye. This fluid is called the vitreous fluid, and the procedure to remove it is called a vitrectomy.
The surgeon will make small openings in the eye and insert special instruments to remove the vitreous fluid. The surgeon will also remove the epiretinal membranes that are causing the macular pucker. This should allow the macula to lie flat against the back of the eye and eliminate the vision problems.
In most cases, surgery puts the macula flat against the back of the eye and allows partial improvement in vision. The best way for the patient to avoid problems and have the best chance of recovering vision is to follow the doctor's advice, use all medications as recommended and keep all appointments with the doctor after surgery.
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