Macular Pucker Surgery & Recovery

Macular pucker surgery addresses macular pucker, a condition in which scar tissue (called an epiretinal membrane, or ERM) forms on the retina. This condition is frequently age-related, slow-progressing, and can even go away on its own.

Sometimes, however, macular pucker can cause blurred and distorted vision and, in some cases, swelling. What causes these symptoms, and how does macular pucker surgery help? Let’s find out.

What is a macular pucker?

Before we get into the specifics of macular pucker surgery and treatment, let’s go over the basics of what creates a macular pucker. Macular puckering occurs when the vitreous, the gel-like substance in your eye, begins to shrink with age. That’s why macular pucker is seen most often in patients over 75 years-of-age.

With enough shrinkage, vitreous can detach from the surface of the retina, a phenomenon called posterior vitreous detachment. Vitreous detachment is a normal process that does not typically cause symptoms (and is different than a macular hole).

However, vitreous detachment can occasionally cause floaters and, in some cases, damage the retina. As the vitreous shrinks, the retina can wrinkle or “pucker.” Typically, the healing response for puckering results in a very thin layer of cells lying on the surface of the retina. These cells are clear and typically don’t create visual disturbances.

In other cases, this healing process may result in an overproduction of cells which form a thicker, more opaque membrane or layer of scar tissue.  A macular pucker occurs only if this scar tissue forms on the macula, the area at the center of the retina. When this occurs, your central vision may become blurred and/or distorted.

A macular pucker can also form following eye trauma, various eye inflammatory diseases, or as an isolated finding (idiopathic). It is not usually associated with medical conditions outside the eye.

Macular pucker is known by a variety of names, including epiretinal membrane, surface wrinkling retinopathy, cellophane retinopathy, and internal limiting membrane disease. All of these names relate to the fact that there is a layer of thin scar tissue on the surface of the macula.

Macular pucker symptoms & diagnosis

The symptoms of a macular pucker are common to many conditions affecting the central part of the retina.

Symptoms can include the following:

• Distortion in lines or letters while reading small print
• A decrease in central vision for distance and reading activities
• Blurring or distortion of images when looking at television or in the theater.

The diagnosis of a macular pucker is made when an ophthalmologist performs a dilated retinal examination and examines the back of the eye. A fluorescein angiogram (injection of a dye into the vein, with photographs taken of the back of the eye) may be recommended to evaluate the situation and determine if leakage or swelling of the retina is taking place as a result of the scar tissue being present on the surface of the macula.

Who should seek macular pucker surgery?

In most cases, epiretinal membrane treatment isn’t recommended. This is due to the fact that the visual distortion and decreased reading and distance vision is minimal in the majority of macular pucker patients.

Surgery would also be considered if vision loss is moderate. However, there is evidence on the fluorescein angiogram of significant leakage posing a threat to permanent damage to central vision in those individuals.

In some instances, however, distortion and vision loss may be significant. Patients may experience an inability to perform certain daily tasks such as reading or driving. It is at this point, that consideration for surgical repair would be entertained.

Macular pucker surgery: How is vitrectomy performed?

Repair of a macular pucker or epiretinal membrane is accomplished via vitrectomy. During this procedure, a surgeon uses specialized microsurgical instruments to gently peel and remove the scar tissue from the surface of the retina.

During the course of the macular pucker surgery, the surgeon must remove the vitreous gel. A fluid which is chemically similar to the fluid naturally produced by cells inside of the eye is used to replace the vitreous.

As part of the procedure, your surgeon will perform a careful inspection for retinal tear or detachment, which can occur in association with the development of a macular pucker. If a tear or break is found, laser treatment may be applied to these areas.

Macular pucker surgery is typically performed under local anesthesia. Some patients remain in the hospital overnight, while others may able to return home by the end of the day of the surgical procedure itself.

A postoperative examination within 24 hours of surgery is required in all cases. Regular follow-up examinations are performed during the first six weeks of recovery, and then at regular intervals after that. Patients typically use eye drops over the course of several weeks following the surgical procedure.

How long does it take to recover from macular pucker surgery?

The macular pucker surgery recovery process is fairly simple. The eye typically recovers from the surgery 10–12 weeks post-op. During this time, the macula should have a chance to return to a more normal configuration. At this point, the patient is measured for glasses. Full visual recovery from the surgery may not occur for at least 3–4 months following the procedure.

As with all surgical procedures, there are potential complications and side–effects associated with the repair of macular pucker. These potential complications include the development of retinal tears or detachments during the procedure or in the immediate postoperative period.

Fortunately, these problems are usually easily repairable. In patients who have not already undergone cataract surgery, development of a cataract may occur more rapidly following vitrectomy surgery. Surgical removal of the cataract and placement of an intraocular lens is then required.

Want more information about macular pucker surgery?

Eye Center of Texas is home to some of the top eye surgeons in the nation. If you’re struggling with blurred and distorted vision due to macular pucker, reach out to us online or call 713-797-1010 to schedule a consultation.