Macular Pucker - a Patients View of Cataract

The Macula is the central portion of the retina, about the size of the head of a pin. This area allows us the quality of vision we need to read, watch T.V. and drive. The Macula is a specialized part of the retina, responsible for the detail vision we require daily.

Vitreous is a Jelly-O like substance of the central part of the eye. As we get older, this jelly shrinks and becomes more condensed to the front of the eye and becomes a liquid. With the shrinking, it pulls away from the retina, called Vitreous Separation. You would notice "floaters" but there would be no damage occuring. At times, the vitreous is attached to the retina firmly. As the shrinking of the vitreous progresses, pulling on the retina occurs, and microscopic to the inner surface becomes damaged. When this damage (irritation) happens in the Macular, the retina begins a healing process with the mobilization of cells within the retina itself. This action is an attempt to heal the damaged area. This irritation is superficial, unlike a macular hole, a thick defect or break in the retina.

Macular pucker (also known as epiretinal membrane, surface wrinkling retinopathy, cellophane retinopathy or internal limiting membrane disease), is a thin layer of scar tissue on the surface of the macular resulting in the wrinkling and distortion of the retina. If this growth is progressive, many cells form and there is a thicker, more opaque membrane of scar tissue on the macula surface. This effect causes distortion in lines and letters (as described above), and decreases the central vision for distance and reading activities.

Macular Pucker is identified by injecting dye into the vein and photographs are taken of the back of the eye. This exam helps to evaluate the condition and determine if there is indeed a leak or swelling in the retina as a result of the scar tissue. In some cases microsurgical instruments are used during a procedure called Vitrectomy. This is the removal of vitreous jell from the center of the eye. Intruments are also used to peal and remove the scar tissue from the retina. If a tear or break is noted, laser treatment is applied. In rare instances, air bubbles and special positioning may be used depending on the
tear or break.

Ten to twelve weeks after surgery, and the macular has returned to normal, the patient is measured for glasses. Full visual recovery may not occur for three to four months after the surgery.

In my case, as with some procedures, there are complications and side-effects. For those of us who have not undergone cataract surgery, developing a cataract may occur more rapidly. Surgical removal of the cataract and implant of an intraocular lens is required. I do hope this article with assist if you are experiencing visual changes.