Macular Holes & Macular Puckers

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Last updated 9/25/2023
Dr. Pilyugina talks about macular holes

What is the macula?

The macula is a part of the eye located in the center of the retina, the light-sensitive tissue at the back of the eye. It's a small, sensitive area that provides central vision and enables one to see fine details clearly.

 

The macula is critical for tasks such as reading, driving, and recognizing faces.  This region also contains a high concentration of cone cells, which are responsible for color vision

What's a macular pucker?

 

What's a Mcular Hole?

A macular pucker, also known as an epiretinal membrane (ERM), is a condition where a thin layer of scar tissue forms on the surface of the macula. This scar tissue can cause the macula to wrinkle or pucker up, resulting in distorted and blurred vision.

 

Macular puckers can develop after eye trauma, a retinal detachment, or in patients with inflammatory conditions. But most commonly, they happen in otherwise completely healthy eyes. In most cases, it’s due to changes in the eye as we age. 

 

What is a macular hole?

A macular hole commonly affects people over the age of 55 and often occurs in females. The vast majority of macular holes develop spontaneously and without cause. It is for this reason that there is no way to prevent their formation or development effectively.

 

While a macular pucker involves tissue forming on the macula, a macular hole is a hole or tear in the macula. Macular holes can seriously affect your ability to drive, read, and do other precision tasks.

 

Much like macular puckers, macular holes occur due to changes in the eye as we age. 

 

The risk of developing a macular hole is increased for:

  • Persons who have had blunt eye trauma
  • Those with high myopia (nearsightedness)
  • Diabetics or those with diabetic eye disease
  • Macular pucker: formation of a scar tissue layer over the macula can become distorted and bent, causing the retina to wrinkle.
  • Vitreous traction: the vitreous is a “gel” that fills up the inside of the eye.
  • Aging, the vitreous can shrink and pull away from the retina, occasionally causing a macular hole. 

 

Individuals who have already suffered a macular hole have a 5% to 15% risk of developing a macular hole in their other eye.

 

Schedule your consultation today with our internationally recognized retina specialists

 

What are the symptoms of a macular pucker and macular hole?

The most common symptoms include:

  • A gradual decline in central vision.
  • Blurred or distorted vision (where straight lines will appear wavy)
  • A growing dark spot in the central visual field.

 

Diagnosing a macular hole or pucker requires a dilated eye exam with a close inspection of the retina. At AGEI we only use the Gold Standard in the industry for diagnostic testing and diagnosis called Optical coherence tomography (OCT).

 

This non-invasive ocular imaging is quick and painless. It allows for the evaluation of the macula in high resolution using reflected light and allows our specialist to differentiate, diagnose, and manage macula holes from other eye conditions and diseases. 

 

 

Treatment for Macular holes and macular puckers

Treatments are determined based on the severity. For minor cases, our specialist may opt for regular check-ups, ensuring that the condition is not deteriorating or causing further complications. 

 

Or surgical intervention may be needed in some instances to avoid additional damage and preserve vision.

 

Macular pucker surgery

Eye drops, medications, or supplements cannot improve vision caused by an epiretinal membrane. The only treatment option is surgery. If your vision is affected by a macular pucker, a vitrectomy may be performed. This procedure involves removing the vitreous gel (gel-like substance inside the eye that helps keep its round shape) and peeling off scar tissue from the surface of the retina.

 

Macular hole eye surgery 

A vitrectomy can also be performed to treat a macular hole. In this case, once the vitreous gel is removed, the eye is filled with a special gas bubble that helps to flatten the edges of the macular hole against the eyewall to allow it to grow back together.

 

Experience Assil Gaur Eye Institute's nationally recognized expertise in treating macular holes and macular puckers

The AGEI ophthalmology group includes a highly skilled retina specialist, Dr. Svetlana Pilyugina, or “Dr. P,” as she is known to her patients. Dr. Pilyugina is an ophthalmologist with fellowship training and board certification in diseases and surgery of the vitreous and retina.

 

Dr. P has extensive experience treating retinal diseases, including age-related macular degeneration, diabetic eye disease and diabetic retinopathy, retinal tears and detachment, flashes, floaters, macular holes, retinal vein occlusion, posterior vitreous detachment, and other complex retinal conditions.

 

In addition to her medical experience, Dr. P is known for her dedication to her patients and focus on personal service. She’s committed to dedicating each day to her patients, offering the highest standards of personalized care. 

 

We are conveniently located for eye care patients throughout Southern California and the Los Angeles area in or near Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Malibu, Manhattan Beach, and Downtown Los Angeles.

 

Assil Gaur Eye Institute has extensive experience in a full range of vision problems, including glaucoma, cataract surgery, LASIK eye surgery, and retinal diseases, to name just a few.

 

Macular holes FAQs

Macular pucker and macular hole FAQs

How successful is Vitrectomy Surgery for ERM?

Epiretinal membrane peels have a very good success rate, and most patients achieve improved visual acuity with reduced distortion. 

 

ERM develops over many months, it takes time (several months) for the retinal surface tissue to relax and resume its normal anatomic shape after surgery. Depending on the size and age of the ERM, in some cases restoring vision completely is not possible.

What's macular hole surgery recovery like?

The surgery performed to repair the macular hole is unique because a gas bubble is placed in the eye. It’s important to follow our specialist post-operative instructions to ensure the gas bubble remains in contact with the macula following surgery. This will allow the macular hole to remain pressed against the eyewall.

 

The patient must lie face down throughout the day and continue this routine for up to 14 days postoperative. This is necessary because the gas rises, and the only way to keep the bubble in contact with the macula is to keep the head in a face-down position. This is extremely important to the success of the surgery since, with proper positioning, the hole has a better chance of healing.

 

The gas bubble will slowly dissolve and shrink over time. While gas is present in the eye, it is critical to avoid airplane or altitude travel until cleared to do so by the surgeon. Gases expand at altitudes and can cause an extreme elevation in ocular pressure, leading to irreversible vision loss.

What is a “full-thickness” macular hole?

A macular hole is considered "full thickness" when it goes through the entire thickness of the retina, from the internal limiting membrane on the surface to the photoreceptor layer at the bottom. This typically occurs at stage 2 and beyond in the progression of a macular hole. These normally won't heal on their own, and macular hole closure surgery may be required.

What’s the closure rate of a macular hole? 

The success rate of surgically closing a macular hole using vitrectomy surgery is as high as 90-95% after a single surgery.

Why is a retinal surgeon the best doctor for macular hole repair?

A retinal surgeon specializes in diseases and conditions that affect the retina, including macular holes. They have extensive training and experience in diagnosing and treating these specific types of eye problems.

 

Repairing a macular hole is a delicate surgical procedure known as a vitrectomy. This surgery is intricate and requires precise manipulation of the retina, skills that our retinal surgeons have developed through years of specialized training.

Is there a natural treatment for macular pucker?

No natural remedy is available for conditions like a macular hole or a macular pucker, also commonly known as an epiretinal membrane. The only scientifically proven method to treat this issue is through surgical intervention, which we typically reserve for more severe instances.

Is macular pucker surgery an outpatient procedure?

Yes, macular pucker surgery, commonly known as a vitrectomy, is typically an outpatient procedure. 

 

 

Sources

Kikushima W, Imai A, Toriyama Y, Hirano T, Murata T, Ishibashi T. Dynamics of macular hole closure in gas-filled eyes within 24 h of surgery observed with swept-source optical coherence tomography. Ophthalmic Res. 2015;53:48–54. https://doi.org/10.1159/000368437.

 

Bacherini D, Savastano MC, Dragotto F, et al. Morpho-functional evaluation of full-thickness macular holes by the integration of optical coherence tomography angiography and microperimetry. J Clin Med. 2020;9:229. https://doi.org/10.3390/jcm9010229.

 

Kelly NE, Wendel RT. Vitreous surgery for idiopathic macular holes: results of a pilot study. Arch Ophthalmol. 1991;109:654–9. https://doi.org/10.1001/archopht.1991.01080050068031.

 

National Eye Institute. Macular Pucker. (https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/macular-pucker...

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