Macular Pucker: Treatment Options and Patient Guidance

Macular folds

Dear Director,
I sincerely apologize for taking up your valuable time.

1.
I would like to inquire about macular folds.
I have heard that there are medications available abroad that can be administered, but they may have some mild side effects.
What would you recommend to patients regarding this treatment?
2.
If surgery is chosen, based on your experience, do you have any statistics on preoperative and postoperative vision improvement (or based on your surgical experience) that you could share with patients? The reason for this question is that many medical journals report that early surgery for macular folds yields better results.
However, in practice, doctors often suggest waiting until vision deteriorates to a certain extent before proceeding, which leaves patients confused.
(If surgery is performed early, there is a possibility that vision may not improve or may even worsen compared to before the surgery.
Conversely, if surgery is delayed, there may be a chance for greater recovery, but the final outcome does not seem to be better than if surgery had been performed earlier.) This often causes patients to worry about how to determine the right timing for surgery.
If there are relevant statistics (or if your experience could provide some guidance), I believe that as patients, we can assess risks based on data or the physician's experience.
3.
Thank you very much for taking the time to read and guide me on these questions.
I am truly grateful.

Xiao Bai, 30~39 year old female. Ask Date: 2021/09/28

Dr. He Jianxian reply Ophthalmology

Currently, there are no medications available for the treatment of macular folds.
Surgery is generally recommended only when the condition has deteriorated to a point that it affects vision or causes distortion in images.
This is because the degree of visual improvement from such surgery is uncertain, so a more conservative approach is typically taken.
Dr.
He Jianxian, Department of Ophthalmology, Nantou Hospital.

Reply Date: 2021/09/28

More Info

Macular pucker, also known as epiretinal membrane, is a condition where a thin layer of scar tissue forms on the surface of the retina, leading to visual disturbances such as blurred or distorted vision. Understanding the treatment options and patient guidance for this condition is crucial for effective management.

1. Treatment Options: Currently, there are no FDA-approved eye drops or medications specifically for treating macular pucker. The primary treatment for significant visual impairment caused by macular pucker is surgical intervention, specifically a vitrectomy. During this procedure, the surgeon removes the vitreous gel from the eye and carefully peels away the epiretinal membrane. While there are anecdotal reports of potential pharmacological treatments, these are not widely accepted or validated in clinical practice. Patients should be cautious about unproven treatments and discuss any potential options with their ophthalmologist.

2. Surgical Considerations: When considering surgery, it is essential to weigh the potential benefits against the risks. Surgical outcomes can vary based on several factors, including the duration of the macular pucker, the degree of vision loss, and the overall health of the retina. In general, studies have shown that patients who undergo surgery for macular pucker often experience improvement in visual acuity. However, the extent of improvement can vary.
According to various studies, approximately 70-90% of patients report improved vision after surgery, with many experiencing a significant reduction in distortion. However, it is important to note that some patients may not achieve the desired improvement, and a small percentage may experience complications such as retinal detachment or cataract formation post-surgery.
The timing of surgery is a common concern among patients. While some studies suggest that earlier intervention may lead to better visual outcomes, many ophthalmologists recommend waiting until the vision has deteriorated to a certain extent before proceeding with surgery. This approach is often due to the unpredictability of visual recovery and the potential for complications.
3. Patient Guidance: For patients contemplating surgery, it is essential to have an open dialogue with their ophthalmologist. Discussing the specific visual symptoms, the impact on daily life, and the potential risks and benefits of surgery can help in making an informed decision. Patients should inquire about their surgeon's experience and outcomes with macular pucker surgeries, as individual surgeon expertise can significantly influence results.

Additionally, patients should be aware that while surgery can improve vision, it may not restore it to pre-pucker levels. The decision to proceed with surgery should be based on a comprehensive assessment of the patient's visual needs and the potential for improvement.

In conclusion, macular pucker is a condition that can significantly affect vision, and while there are no current pharmacological treatments, surgical options are available. Patients should engage in thorough discussions with their healthcare providers to understand the timing and implications of surgery, as well as to set realistic expectations for visual recovery. Regular follow-ups and monitoring are essential to assess the progression of the condition and to make timely decisions regarding treatment.

Similar Q&A

Understanding Macular Pucker: Monitoring and Treatment Options Explained

Hello, Doctor. I have myopia in both eyes, with a degree of -1000. Three years ago, I checked the Amsler grid, and the horizontal lines were normal, while the vertical lines were slightly wavy but returned to normal. I also had an OCT of the retina, which was normal. My vision te...

Dr. Gao Pilin reply Ophthalmology
Hello KEN Tsai: 1. The doctor suggests that six months should be acceptable, and currently, there are no methods to reduce the deterioration. 2. It is possible. If it significantly affects vision, surgery may need to be considered.

Understanding Retinal Tears and Membranes: Insights and Management

Dear Dr. He, Three months ago, during a routine eye examination for my high myopia, a peripheral retinal tear was unexpectedly discovered in my right eye. The clinic physician performed laser photocoagulation at that time. Recently, during a follow-up visit, a macular pucker was...

Dr. He Jianxian reply Ophthalmology
Macular folds are essentially a natural occurrence, likely caused by the traction between the retina and the vitreous due to vitreous degeneration. Currently, there are no appropriate preventive or therapeutic measures available in clinical practice. As for the blue light you see...

Understanding Treatment Options for Macular Edema: A Patient's Guide

Hello, doctor. I would like to ask a few questions. I have noticed dark spots in my vision and visited a clinic where an optical coherence tomography (OCT) scan revealed signs of edema. The doctor did not diagnose me with macular degeneration but indicated that there is edema bas...

Dr. He Jianxian reply Ophthalmology
Hello, sir: If there is a suspicion of macular edema, it is recommended to first perform fluorescein angiography. If significant leakage points are found at a certain distance from the macula, direct laser treatment can be very effective and does not incur additional costs. If la...

Understanding Macular Pucker: When Is Treatment Necessary?

Doctor, I went to see a retina specialist who said I have a macular fold! At what level of vision does treatment become necessary? I have had cataract surgery. Thank you.

Dr. Wang Zhishun reply Ophthalmology
Vision is not the only criterion; factors such as the underlying cause, thickness, and impact on the surrounding tissues should also be considered. It's best to discuss this with your physician.