Retina and macular pucker
Macular pucker is a disease of the retinal surface and its interface with the vitreous humour. It is characterized by the proliferation and wrinkling of an epiretinal membrane; so it is a layer of connective tissue which grows on the surface of the retina, in particular on the macula, which is the central part of the eye where distinct, high-resolution vision has its seat.
This membrane originates from the cells of the layer underlying the retina: the retinal pigment epithelium (RPE). These, often coinciding with peripheral retinal alterations, may “fall” into the vitreous cavity and then slowly settle down in the macular seat until forming a surface membrane that covers the macular surface, upon which it may therefore exert traction and consequently “wrinkle” it. With ageing, the vitreous body, which is located in the back side of the eye behind the retina, begins to withdraw, resulting in wrinkling as well as in the possibility of transmitting a traction force to the macular seat. This can subsequently evolve into the formation of a macular hole that often results in a significant visual loss.
The diagnosis is made only through a comprehensive eye examination with pupil dilation. The OCT test is essential in making the retinal situation clearer and more certain. It is often useful to perform a fluorescein angiography as well. In selected cases and after an appropriate follow-up period and repeated OCT tests, we perform the surgical removal of the macular pucker and epiretinal membranes with a micro-invasive and sutureless technique, that is, without applying suturing stitches. See minimally invasive vitrectomy.