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Macular Pucker Surgery

A macular pucker is also known as epiretinal fibrosis, preretinal fibrosis, wrinkled retina, and a number of other terms, which are all synonymous.  These terms all refer to scar tissue or fibrosis forming on the surface of the retina.  This tissue can form as a result of aging, trauma, or other pathological processes.  Once the tissue forms it tends to contract and wrinkle or pucker the underlying retinal tissue.  This can result in blurred and distorted vision.  Macular pucker surgery is performed by using a technique known as “vitrectomy surgery”.  Please see the section on vitrectomy surgery for a basic description of the procedure.  The purpose of macular pucker surgery is to remove the tissue which is causing the wrinkling of the retina.  In most cases this will allow the wrinkling to slowly improve or completely resolve in some cases with a decrease or resolution of the visual blurring and distortion.

For this procedure we preferentially use a 25-gauge vitrectomy technique, which involves the use of very small cannulas, or tubes, to enter the eye.  This rarely, if ever, requires stitching the wounds closed following surgery.  This provides better patient comfort and faster healing.

During the technique, following the vitrectomy or removal of the vitreous gel, the scar tissue is peeled from the surface of the retina with small grasping forceps.  In addition to this, any vitreous floaters in the eye are removed.  Sometimes a vital tissue dye, known as brilliant blue dye, is used to stain the retinal tissue to ensure that all of the pathological tissue has been removed from the vital areas.  The procedure usually takes less than an hour in most cases.  Although sometimes gas or oil is injected into the eye following vitrectomy surgery, it is very rarely needed in these cases, so postoperative positioning is uncommon.

The outcome of the surgery can depend on a number of different factors.  One is the duration of the macular pucker.  Patients that have had the macular pucker for over a year, or in some cases many years, may have already sustained permanent cellular damage to the retina, and the visual improvement can be significantly limited in these cases. 

Patients can achieve very good vision following macular pucker surgery, but the visual outcomes can vary.  In general, however, most patients will see a significant improvement in vision of several lines of vision on the eye chart.  Postoperatively, there can be persistent visual distortion and blurred vision, which may not be correctable with glasses.

Patients that have never had cataract surgery are at risk for developing a cataract, which may require surgical removal to achieve the best visual outcome.

As with any surgical procedure there are risks associated with this surgery, but most of the risks are uncommon.  The most common risk is a cataract forming in patients that have not had previous cataract surgery.  Other risks can include a postoperative wound infection, retinal detachment, intraocular bleeding, glaucoma, and even loss of the eye.  However, it must be kept in mind that the likelihood of the vision improving in the eye without surgery is extremely unlikely.

Please see the video links which describe the various surgical procedures for specific disease conditions.

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