Retina Specialists

Phone: 205.933.2625

Macular Pucker, Macular Hole & Macular Surgery

Macular Pucker or Epi-macular Proliferation (EMP) occurs in later adult life usually in one eye but it can develop in both eyes. Cells accumulate (proliferate) on the surface of the retina on the macula. These cells form a membrane over the macula that can contract wrinkling the retina like a crushed piece of cellophane wrap. The term cellophane maculopathy is a description sometimes used in early stage that in later stage is described as macula pucker. When the retina is misaligned, visual symptoms range from wavy distorted vision to double vision. Traction on the retina from the membrane can cause the macula to swell. An even greater loss of visual function is noticed and in time, if untreated, it becomes less and less likely that vision can be restored with surgery.

In the past because of the risk of intraocular surgery some ophthalmologists advised waiting to treat until significant vision was lost. In part because the membrane does not diminish vision in some individuals but for those who do experience disturbing symptoms retina surgeons can now operate with confidence in the safety of vitrectomy and with procedures to eliminate the former risk of retinal detachment. Contemporary instrumentation and preventative treatment against retinal detachment with indirect laser cerclage significantly reduces risks. Surgeons now understand that as vision is lost the restoration and prevention of loss is best achieved before these changes become serious.

Helen Keller Foundation for Research and Education researchers added to the success of this surgery by demonstrating the value of removing the internal limiting membrane (ILM) as well as the abnormal membrane in the same procedure. The ILM is the foundation of the abnormal cell accumulation and removing it does not damage vision but rather removes the base for future accumulation and ensures complete removal of abnormal membranes.

Macular Holes, very much like EMP, share a common history of treatment as well as more positive outcome with ILM remove. Macular holes also occur in older adults and usually happen in one eye but can occur in both eyes. In the early stages symptoms are similar to EMP; straight lines look wavy, crooked or even broken. In some rare cases holes can reseal without treatment but by far the majority of cases have the best prognosis with early intervention.

Once all traction has been removed from the retina by removing vitreous and the ILM a long lasting retinal splint is placed within the eye to support the newly freed retina to rest back in a smooth position on its underlying source of nourishment. A gas bubble is placed within the eye to act as the splint. The bubble will last several weeks until the retina heals in the newly closed and attached position. While the bubble is in place your surgeon may advise you to take advantage of the support of the splint by positioning your head in a downward position allowing the bubble to float back towards the retina rather than the front of the eye. Many people are apprehensive about this aspect and dread it very much but most people find they can manage quite well without as much discomfort as feared. Your surgeon will give you instructions specific to your eye. The bubble will gradually be absorbed and dissipate. Vision can gradually improve over time.

Macula Surgery is an intraocular form of microsurgery performed by vitrectomy. With increasingly smaller and smaller gauge instruments retina surgeons are able to enter the posterior portion of the eye into the vitreous cavity. Vitreous is a semi-liquid, gel like substance that fills the globe of the eye. Vitreous plays a roll in early embryonic development of the eye but has no further function for health or vision. Once this substance is removed from the eye the surgeon has access to delicate retinal tissue enabling a variety of procedures and techniques for treating the retina including the macula. The macula is the portion of the retina that gives us our fine, detail vision. It is the area of vision that allows us to read, to recognize faces, and to distinguish colors. There are a number of conditions of the retina that may be treated with surgery by a retina surgeon.

The vast majority of operations on the macula are performed to relieve traction on its surface. Less frequently, macular surgery is performed to treat aged related macular degeneration.