The macular pucker is an affection of the eye, which arises due to an alteration of the vitreous humor resulting in the formation of fibrous-cicatricial tissue at the macula, or the central area of the retina.
When the macular pucker is symptomatic, cause: loss of sight, blurred or distorted vision, altered perception of lines and difficulty in reading small characters.
The treatment depends on the presence or not of a serious symptomatology: if the manifestations are mild and do not condition everyday life, we prefer not to intervene; on the contrary, if the symptoms prevent even the simplest daily activities from being performed, it is advisable to resort to a vitrectomy operation.
Short review of the anatomy of the eye
In the eye (or eyeball ) three concentric portions can be recognized, which, from the outside towards the inside, are:
- The external tunic, which acts as an attack for the so-called extrinsic muscles of the eyeball; in it reside sclera (posteriorly) and cornea (anteriorly). It has a fibrous nature.
- The medium cassock (or uvea ), which is a membrane of connective tissue, rich in blood vessels and pigment.
Interposed between sclera and retina, it deals with providing nourishment to the retina, or rather to the layers of retina with which it comes into contact.
Includes iris, ciliary body and choroid.
- The inner robe, which is formed by the retina.
The retina is a transparent film consisting of ten layers of nerve cells (real neurons), including the so-called cones and rods. Cones and rods are deputies to the visual function.
The internal habit, as can be guessed from what has just been said, has a nervous nature.
What is the macular pucker?
The macular pucker is a morbid condition of the eye, following an alteration of the vitreous humor and characterized by the appearance of fibrous-scar tissue at the level of the macula, or the central area of the retina .
After the appearance of this fibrous-cicatricial tissue, the entire retina tends to undergo a contraction, similar to a wrinkling, which could affect its visual functionality.
WHAT IS MACULA?
The macula, or macula lutea, is the central area of the retina of the human eye.
Similar to a yellow spot with a diameter of about 5.5 millimeters, it contains more cones than rods and represents the most sensitive retinal area to light stimuli.
Moreover, it is the part of the retina responsible for the perception of details and the greater visual acuity.
In it we can distinguish at least 4 regions: two of these are particularly important and are better known as fovea and foveola .
The yellow color that distinguishes the macula is due to the presence of two carotenoids: lutein and zeaxanthin.
UMOR VITREO: SOME ADDITIONAL INFORMATION
The vitreous humor (also called the vitreous body ) is the gelatinous and transparent substance that resides in the so-called vitreous chamber and which acts as a support:
- for the crystalline lens, in the anterior part of the eyeball;
- for the retina, in the back of the eye.
Colorless and with a constant volume, the vitreous body is made up of 98-99% water and other substances such as: hyaluronic acid, salts, sugars, vitrosine (a type of collagen, therefore a protein), opticine (a protein), type II collagen and other proteins. Thanks to this composition, it ensures the maintenance of the spherical shape of the eye.
The vitro humor has no blood vessels and is crossed by the hyaloid canal, which goes from the optic papilla (or the emergence of the optic nerve within the eyeball) to the hyaloid fossa (ie the posterior part of the crystalline lens).
SYNONYMS OF MACULAR PUCKERS
Macular pucker is also known by many other names, including: epiretinal membrane, premacular membrane, retinal wrinkle, cellophane maculopathy and premacular fibrosis .
Frequently asked questions about the macular pucker
Q: Is macular pucker and macular degeneration the same thing?
A: No, although they cause very similar symptoms, they are two different conditions. A doctor who specializes in eye diseases is able to distinguish them without any particular problems.
Q: Can the macular pucker also be called a macular hole?
A: No, because macular pucker and macular hole are two distinct eye diseases. In the first case, fibrous-scar tissue is formed on the retina; in the second, the macula undergoes a real break. However, it is possible for the macular pucker to degenerate into a macular hole.
The vitreous humor is bound to the surface of the retina by means of fibers (mostly proteic in nature) very thin. These fibers fix the same retina in the most suitable position to perform its visual functions.
As a result of aging or when certain circumstances arise, the vitreous body shows a tendency to withdraw and interact less and less with the retina.
This process - also called posterior vitreous detachment - can cause retinal lesions, lesions that lead to the formation of fibrous-scar tissue to be repaired.
The neoformation of fibrous-cicatricial tissue causes a contraction of the retina, as if something pulled it.
The macular pucker arises following the procedure described above.
In most cases, posterior detachment of the vitreous humor has no consequences. Only in rare cases, in fact, does it determine the process of which the main stages have just been described.
FAVORING AND CHANGING CONDITIONS
In addition to aging, the macular pucker can also arise due to:
- A condition of diabetes . This metabolic disease can be responsible for several vision problems, which take the generic name of diabetic retinopathy.
- A tear or a detachment of the retina
- An ocular trauma
- An inflammatory disease of the eye
- Late effects of cataract surgery
IDIOPATIC MACULAR PUCKER
Many cases of macular puckers are of an idiopathic nature.
In medicine, the idiopathic term associated with a pathology indicates that the latter has arisen without obvious and demonstrable reasons.
Symptoms and Complications
The macular pucker causes changes in vision .
Specifically, it can cause symptoms such as:
- Loss of sight. In general, patients lose the visual ability to distinguish the details of an object, regardless of whether it is near or distant.
- Blurry or moderately distorted vision
- Perception of straight lines as if they were wavy or broken lines
- Difficulty in reading small characters
Over time, this symptomatology can remain stable or worsen.
ASINTOMATIC MACULAR PUCKER
Several cases of macular puckers lack a noteworthy symptomatology: in these situations we also speak of asymptomatic macular pucker .
The reason or reasons why some individuals do not show any symptoms are still unknown; just as it remains to be clarified why some patients who have always been asymptomatic suddenly complain of certain sight disorders.
MONO OR BILATERAL PULLEY?
In most circumstances, the macular pucker is unilateral, meaning it only affects one eye.
However, it is good to remind readers that sometimes the formation of fibrous-scar tissue can affect both eyes. In these situations, there is also talk of bilateral macular pucker .
WHEN TO REFER TO THE DOCTOR?
Doctors advise contacting an eye disease expert as soon as the first visual disturbances are felt.
It will then be the task of this expert to investigate the reason behind the various sight problems and to plan the most appropriate therapy.
The diagnostic procedure for identifying the macular pucker includes:
- An examination of the fundus
- A computerized optical tomography (OCT)
- A retinal fluorangiography
EXAMINATION OF THE EYE BACKGROUND
The examination of the ocular fundus is a diagnostic procedure that allows to study the internal structures of the eyeball, therefore also the vitreous body, the retina and the macula.
Although it requires the use of some eye drops to dilate the ocular pupil, it is not a particularly invasive test.
COMPUTERIZED OPTICAL TOMOGRAPHY (OCT)
Computerized optical tomography ( OCT ) is a reliable and non-invasive diagnostic test that provides scans of the cornea and retina.
With a total duration of 10-15 minutes, it involves the use of a laser beam without harmful radiations and can be carried out even without necessarily having to dilate the patient's pupil.
Fluorescence retinal angiography is a photographic diagnostic procedure that allows the identification and study of vascular diseases of the eye.
It is based on the use of a dye, fluorescein, which, after being injected into a vein, spreads in a circle.
Thus, the diffusion of fluorescein is followed by means of an instrument - the retinograph - capable of taking real photographs (or frames) of the blood flow inside the retinal vessels.
The examination takes about 10 minutes and may be slightly annoying when the dye is given into a vein.
If it lacks a symptom worthy of note or is completely asymptomatic, the macular pucker does not require special treatment .
In other words, if the patient is able to carry out all normal daily activities (from driving to reading a text), he must not undergo any therapy.
The situation changes completely when the macular pucker influences everyday life, severely impairing visual skills.
In circumstances like these, it is necessary to resort to surgery and, in this case, to an operation called vitrectomy .
Why not even operate with minimal symptoms?
As will be seen, the vitrectomy operation is not entirely risk free; therefore, if the symptomatology is minimal, it is not worth taking the risk of worsening the state of health of one's eyes.
Vitrectomy is the surgical procedure of total or partial removal of the vitreous body, carried out in order to fix a vision disorder.
In the case of the macular pucker, after the removal of the vitreous humor, the ophthalmologist operating (NB: the ophthalmologist is a doctor specialized in the study and treatment of eye diseases) provides to "fix" the damage to the macula . To fix it means that it eliminates the scar tissue that tends to contract the affected macular area.
To know in detail what the whole vitrectomy procedure involves, it is advisable to consult the article on this page.
Vitrectomy in its highlights:
- Duration 1-2 hours. However, in some cases, it can also last for 3 hours.
- It can be performed under general or local anesthesia. In the first case it requires some special precautions and provides for a day's hospitalization.
- After the operation, the doctor's instructions must be strictly followed. The use of eye drops is foreseen, to avoid infections.
- Main complications: cataract and retinal detachment.
Vitrectomy performed on the occasion of a macular pucker gives more than appreciable results. In fact, in general, patients recover a good part of their sight and improve their ability to see details, straight lines as they really are, etc.
Recovery for macular pucker surgery usually requires at least three months .
Being often due to aging or unknown causes, the macular pucker is a generally difficult condition to prevent.