Information For Our Patients About Macular Puckers
Once you have a basic understanding of the eye, you can understand how your eye problem interferes with vision. In a manner similar to a camera, light enters in front of your eye through the cornea and lens. The light is then focused on the back of your eye on the tissue called the retina. In a sense, the retina functions like the film in a camera. From there, the signals are transmitted to the brain, thereby creating sight. The center of the retina is called the macula. The macula is responsible for sharp, central vision, which allows us to recognize details required for reading, driving, sewing, etc. If the macula is damaged by disease, the "straight ahead" vision is affected. The rest of the retina is responsible for side or peripheral vision.
A macular pucker is a condition in which a thin, elastic, nearly transparent membrane forms over the surface of the macula and causes the macula to be wrinkled. You may wonder why this happened to you. In all of us, there is a clear, jelly like substance which fills the eye called the vitreous. As a part of the normal aging process, this vitreous gel turns into a liquid, shrinks, and pulls away from the retina. Although the vitreous is usually only loosely attached to the retina and pulls free without a problem, in your eye the vitreous gel was more strongly attached. When the vitreous pulled away it damaged the surface of the macula. In simpler terms, it left a raw, abraded surface. In an attempt to heal this raw, damaged surface, your eye formed a thin scar or membrane over this area.
If the healing attempt stopped there, no problems would have been encountered. Unfortunately as is often the case, your membrane contracted (shrunk) and formed wrinkles in your macula. Consequently, your straight ahead vision became distorted or blurred.
A surgical procedure called "vitrectomy" can be performed to remove this macular pucker if the surgeon feels your benefits outweigh your risks. The purpose of the surgery is to carefully remove this membrane which has caused the macula to be wrinkled and also to remove a portion of the vitreous gel. The vitreous gel is replaced with a clear salt water solution, similar to that which the eye produces normally. Once the membrane has been removed, the macula will have a chance to smooth again, so that the vision can be less distorted. In all cases, the surgery can be done as an outpatient procedure under local anesthesia.
Eighty five to ninety percent of patients notice a measurable improvement in vision after this surgery. With a good outcome, your eyesight will be improved and/or your distortion will be reduced. As with any surgical procedures there are risks. The substantial benefits usually outweigh the infrequent development of retinal tears, detachment, or other problems. Furthermore if a retinal tear or retinal detachment occurs, they are usually readily treatable.
