Macular pucker, also known as epiretinal membrane surface wrinkling retinopathy, retinopathy of cellophane, and internal limiting membrane disease, is a condition in the macula it becomes wich met, contracted and wrinkled. In fact in this eye disease there is abnormal growth of cells on the macula (retina specialist responsible for clear and detailed picture area). This abnormal growth of cells results in distorted vision ("wavy" vision), blurred central vision, gray area in central vision, central point of the blind and the inability to see the details leading to difficulties in reading and other tasks requiring details seeing.
The disease is not reversible and the only procedure that can restore vision is macular pucker surgery.
There are many causes of macular pucker and many conditions that can lead to macular pucker: eye injury, inflammation inside the eye (uveitis), a torn or detached retina (retinal detachment surgery earlier thereof), problems with the vessels retinal blood (branch retinal vein occlusion - BRVO occlusion and central retinal vein - CRVO), vitreous detachment or aging the gel (vitreous) inside the eye. After the age of 50 in the macula begin to gradually build up scar tissue attaching to the internal limiting membrane (macular smooth and shiny surface). This scar tissue by floating cells is formed downward from the vitreous cavity, once cells reach ILM begin to produce collagen. This collagen binds cells together in a structure called epimacular proliferation (EMP). EMP contracts and most wrinkles thickness macular pucker causing the macula.
If macular pucker not very severe symptoms because of distortion and reduced vision of a treatment through the macular pucker surgery is not necessary, but the symptoms can be improved by changing lenses that improve the enlargement. At this point, eye drops, laser surgery or drugs do not improve vision.
But when symptoms are severe and when vision is deteriorating doctors recommend surgery macular pucker.
Macular pucker surgery It is achieved by using vitreoretinal surgery.
The first procedure described macular pucker surgery was standard flat vitrectomy pars (VPP). In this procedure macular pucker surgery, use of a light pipe, an infusion line of clear liquid and a vitreous cutter / aspirator, all about the size of a pen point of ball filling, the vitreous is removed by display microscopic. The eye is kept inflated by liquid. Special care to gently remove the clear glass that can remain attached to the macula (the cortical vitreous) .The next step in this procedure macular pucker surgery, assuming no allergies to iodine have is the instillation of indocyanine green ( ICG) dye color the macular ILM surface in order to help substantially later dissection. With a delicate tweezers the EMP is removed. ICG dye can be re-injected into macular pucker surgery to demonstrate more fully the underlying distorted ILM, and this layer can also be removed for the complete liberation of traction. It may also be possible to eliminate the EMP / ILM complex on a single sheet. This method of surgery macular fold standard itself is usually performed under local anesthesia, sometimes a patient will have to stay in hospital overnight, but more often are able to return home at the end of that day.
In recent years, a new technique of macular pucker surgery was developed: Limit tire inner membrane separation (ISCED). This new technique of macular pucker surgery allows surgeons to safely remove and quickly abnormal macular tissue and wrinkled internal membrane layer gently lifting and separating fluid pressure, while smoothing the underlying distorted retinal layer. In this new procedure macular pucker surgery, doctors use a tiny tube placed in parallel to the layer below the retina neural layer ILM. In a step of this technique macular pucker surgery, ILM and EMP are lifted in a quick, simple, coherent and comprehensive approach. Compared to the standard procedure macular pucker surgery, instead of trying to provoke and make the EMP of the surface of the retina of a piece at a time with tweezers, MOVIES potentially reduces the risk of macular pucker surgery and may allow that patients and eye doctors consider surgery before long-term damage to the nerves in the retina causes irreversible vision loss.
There are many studies on macular pucker surgery.
One such study has shown that a second vitreoretinal procedure due to threatening complications vision after macular pucker surgery may have to be made in some cases. But compared to the spontaneous course of the disease, the standard macular pucker surgery through pars plana vitrectomy has a very positive influence on the operational parameters.
Another study has shown that macular pucker surgery by pars plana posterior vitrectomy with epiretinal membrane peeling and release of the MLI (maculorrhexis) can be removed with macular pucker success, improve vision and relieve metamorphopsia.
The purpose of a study is to describe the occurrence of massive macular edema and visual loss after power green (ICG) indocyanine macular fold Surgery; the case report indicated that ICG could contact the bare retina if injected after removal of epiretinal membranes.
Double vital staining was also studied using trypan blue and green infracyanine in macular pucker surgery. The described double staining technique could be a valuable new tool that can help achieve optimal anatomical and functional recovery after macular pucker surgery.
Another study showed that intravitreal dexamethasone effectively reduces postoperative inflammation after vitreoretinal surgery (macular pucker).
The clinical characteristics and comparative immunohistochemistry suggest that acute macular pucker is a
distinct clinicopathologic entity. Patients with acute macular pucker have precipitated visual loss caused by the formation of epiretinal membrane after retinal detachment or tear. Early macular pucker surgery in these patients results in a quick recovery of visual acuity and resolution of metamorphopsia.
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