Macular pucker is a condition where a fine layer of scar tissue forms on the surface layer of the retina, causing wrinkles that can distort and blur vision. Common synonyms for macular pucker includes epiretinal Membrane and cellophane maculopathy. The formation the scar tissue is very common in eyes of people over the age of 70 because it is usually triggered by collapse of the vitreous gel within the eye as a normal aging process. In the vast majority of people, the mild surface wrinkling does not cause any significant visual disturbance.
The most common symptoms from macular pucker includes blurred vision, distortion causing lines to appear bent and occasionally “image rivalry” which occurs because the two eyes see different images and this confuses the brain.
Macular pucker only needs to be treated if the patient is symptomatic.
Patients who are asymptomatic are regularly reviewed for any progression, whereas symptomatic patients will be offered surgical intervention.
The surgical procedure is called a vitrectomy and involves the removal of the surface scar tissue and allows the retina to return to its near normal location. Surgery is performed in the operating theatre under sedation after local anaesthesia has been achieved.
The surgical procedure was pioneered by Prof. Robert Machemer in the 1970’s and A/Prof Heriot was trained by Prof Machemer himself at Duke University Eye Centre in the United States.
Firstly, it is important to note that the scar tissue process is not just a retinal surface change but that there are also reactive changes within the retina itself. As such the vision does not always return to complete normality. There can be some residual distortion and some blurring despite an ideal removal of the scar tissue from the retinal surface.
Please note: the intraocular manipulation performed during vitrectomy surgery causes physiological changes triggering progressive cataract formation and can result in sub optimal clarity for many months, until cataract surgery is performed. Therefore in some patients, it is advantageous to perform combined cataract surgery with vitrectomy, which offers much faster visual rehabilitation. This will be discussed on an individual basis by your ophthalmologist.
Other uncommon risk factors include intraocular infection, retinal tears, retinal detachments, haemorrhage or inflammation or damage form the bright light used to see inside the eye during the surgery.