Angeles Vision Clinic
The Macula, which is a specialized area of the
retina, is responsible for clear, detailed vision. Epithelial Membrane or
Macular Pucker is an abnormal growth of cells over the macula.
In order to maintain its round structure, the central portion of the eye is filled with a jelly-like substance known as the vitreous. As a person ages, the vitreous jell begins to shrink and becomes more condensed or shrinks. As this shrinkage and forward movement of the vitreous progresses, traction or pulling can be exerted on the retina, resulting in microscopic damage to its inner surface. When this focal area of damage or irritation occurs in the macular region, the retina initiates a healing response with mobilization and migration of cells found within the retina itself. These cells then spread outward along the surface of the retina.
This thin layer of scar tissue is known as a macular pucker. 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 which results in a mechanical wrinkling and distortion of the retina leading to decreased vision. This membrane can often be removed (see illustration).
Clinical photo and artists drawing of macular pucker
In most cases, this healing response is mild, and results in a very thin layer of cells lying on the surface of the retina. These cells may be clear and produce no significant visual disturbance or progress to form a thicker, more opaque membrane leading to significant vision loss.
In most patients, this process is slow and self limiting and eventually the scar tissue stops proliferating or extending.
With time, the membrane in some eyes may contract causing a wrinkling of the underlying retina. When this occurs in the central, critical portion of vision, the macula, visual symptoms result.
Symptoms of a epithelial
What should be done if an epithelial membrane is
Repair of a macular pucker or epiretinal membrane is accomplished through use of vitreoretinal surgery. Using microsurgical instruments, a procedure known as a vitrectomy, the microscopic removal of vitreous jell from the center of the eye, is performed. During vitrectomy, any vitreous attachment will be removed from the central macular region. Specialized microsurgical instruments are then used to gently peal and remove the scar tissue from the surface of the retina, relieving the traction and reducing the distortion to the retinal surface.
The surgical procedure itself is typically performed under local anesthesia, occasionally a patient will need to stay in the hospital overnight but most often they are able to return home by the end of that day. 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 utilize several eye drops applied to the operated eye over the course of several weeks following the surgical procedure.
Approximately 10-12 weeks after surgery, when the eye has recovered from the surgery and the macula has had a chance to return to a more normal configuration, the patient is measured for glasses. Full visual recovery 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 repair of macular pucker. These include a small percentage of patients that develop retinal tears or detachments during the procedure or in the immediate postoperative period. 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.
Frequently asked questions:
Are macular pucker, macular hole and macular
degeneration related in any way?
If I have surgery, what type of vision
improvement can be expected?
How soon will I get my vision back?
Does the scar tissue or the macular pucker
ever grow back?
Please note that much of the above content was provided compliments of: Vitreous-Retina-Macular Consultants New York