Macular Hole & Macular Pucker
The retina is the photosensitive tissue lining the back wall of the eye and the macula is the central region of the retina. The macula is the region that allows one to have reading vision and perform tasks that require high definition.
What is a macular hole?
A macular hole is caused by a defect in the very center of the macula with the symptoms being the loss of reading vision. Although blunt trauma to the eyeball can cause a macular hole, the usual causes are attributed to an aging process called posterior vitreous detachment (PVD). Although untreated macular holes do not lead to blindness when diagnosed early (within one year after the onset of symptoms), vitrectomy surgery has a good chance of recovering significant vision. A gas bubble is commonly utilized as an adjunct to such surgery.
Learn more about macular hole at ASRS.org.
Causes
Most macular holes develop spontaneously without clear cause, though some may be related to trauma, prior swelling or inflammation of the retina.
Diagnosis
They are diagnosed with a dilated eye exam and non-invasive imaging called optical coherence tomography.
Treatments
The most common and most effective treatment for macular holes is a surgical procedure called vitrectomy.
What is a macular pucker/epiretinal membrane?
For reasons not understood, the separation of the vitreous gel inside the eye (posterior vitreous detachment – PVD) can be associated with a reparative process in which fibrous cells form a film on the surface of the macula. This film of tissue is often called an epiretinal membrane or a macular pucker. This film of tissue has contractile properties that can cause the surface of the macula to wrinkle. This wrinkling can elicit symptoms such as distortion and blurring of vision. When the symptoms become bothersome enough, vitrectomy surgery to remove the film may be beneficial.
Causes
They most commonly form as a result of an aging process of the eye that causes the internal gel to liquefy and separate from the surface of the retina. Some cases may be related to prior trauma, inflammation in the eye, diseases of the retinal blood vessels, or prior eye surgery. They are often found incidentally on routine eye exams.
Diagnosis
A non-invasive imaging test called optical coherence tomography is helpful for diagnosis and to monitor for change over time.
Treatments
Most macular puckers are mild, cause minimal symptoms, and do not require treatment. However, they can progress over time and some result in significant blurring or distortion of the central vision. These cases can be treated with surgical removal called vitrectomy with membrane peel.
How are macular holes and macular puckers diagnosed?
Macular holes and macular puckers both cause disturbances of central vision. The symptoms of macular holes and macular puckers may be similar to the symptoms of wet macular degeneration, but the treatments and their urgencies are vastly different. If one notes central blurring with distortion, then an evaluation by an ophthalmologist would be recommended. Imaging studies that include optical coherence tomography (OCT) are often utilized.