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Macular Pucker


What is the macula?

At the centre of the retina is a special area called the macula, the part of the eye which sees most clearly. The retina is the inside layer of the eye which is sensitive to light. A damaged macula causes blurred sight.

What is macular pucker?

Normally the macula lies flat against the back of the eye, just as paper does when it runs through your printer. If a macula pucker appears the macular becomes wrinkled, like paper in your printer when you’ve got a paper jam. Other names for this condition are cellophane maculopathy, premacular fibrosis or epiretinal membrane.

What are the symptoms of macular pucker?

The symptoms are blurred and distorted vision and straight lines such as pillars or electric light poles often appear wavy.

What causes macular pucker?

The macular pucker appears as a thin, transparent layer of tissue which grows over the macula. Fully grown it contracts and shrinks, wrinkling the macula. There are several conditions that may be associated with macular pucker, such as:

  • detachment of the transparent jelly which fills the main cavity behind the lens in the eye (vitreous detachment)
  • disorders of the retinal blood vessel
  • severe eye injury
  • torn or detached retina
  • inflammation inside the eye

How can it be detected?

Your retina has to be examined by an ophthalmologist. To determine the extent of the damage to the macula a fluorescein angiogram (photographic test) may be done. Macular pucker is not usually related to any medical problem outside the eye. However, one or both eyes may be affected and vision loss can vary from barely noticeable to severe. Usually the vision does not get progressively worse and remains stable.

How can macular pucker be treated?

If both eyes are involved, magnifier or strengthened bifocals may improve near vision. Otherwise, if your symptoms are mild treatment is not necessary and therefore medicines, laser surgery or eye drops do not reduce the symptoms or improve vision.

The only treatment that can remove macular pucker is by using vitrectomy surgery. In this surgery tiny instruments are used to remove the membrane that wrinkled your macula. After the surgery the macula usually flattens out and the symptoms slowly improve. Although vision does not usually return all the way back to normal, there is considerable improvement. However, cataracts may develop sooner. The cataract is the condition where the lens of the eye gradually becomes hard and opaque.

Not every patient who has macular pucker necessarily needs surgery. Surgery should be considered if the blurred vision is interfering with your daily activities. Although complications are uncommon infections, bleeding, re-occurrence or retinal detachment could occur.

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