Macular Holes & Macular Puckers

What's a macular pucker?

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.

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.

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...