Macular Pucker: When to Treat and What to Expect

Macular fold

My mother recently underwent an examination to determine if she needed cataract surgery.
During the examination, it was found that both eyes had mild macular folds (my mother is 69 years old).
However, her vision is still 0.6, and there is no distortion in her visual perception.
The doctors advised that surgery is not necessary at this time.
Why is it that, despite the discovery of the condition, early treatment is not required, and she can only be monitored? Additionally, will vision after surgery for macular folds be better than before the surgery? Thank you, Dr.
He.
🙏

Liao Xiaofeng, 40~49 year old female. Ask Date: 2023/04/24

Dr. He Jianxian reply Ophthalmology

If there is significant vision loss or visual distortion due to macular folds, surgery is recommended.
After surgery, some individuals may experience improvement, while others may only maintain their current condition without significant changes.
Therefore, based on your mother's situation, it seems that monitoring is sufficient.
Dr.
He Jianxian, Ophthalmology Department, Nantou Hospital.

Reply Date: 2023/04/24

More Info

Understanding macular pucker, also known as epiretinal membrane, is crucial for patients experiencing vision changes, especially in older adults. A macular pucker occurs when a thin layer of scar tissue forms on the surface of the retina, specifically in the macula, which is responsible for central vision. This condition can lead to visual distortions, blurriness, or even a decrease in visual acuity, but it often progresses slowly.

In your mother's case, the fact that she has been diagnosed with mild macular pucker but still maintains a visual acuity of 0.6 (which is approximately 20/40 vision) and does not experience any distortion is a positive sign. The decision to delay surgical intervention is often based on several factors:
1. Severity of Symptoms: If the patient is not experiencing significant visual disturbances or a decline in vision, doctors may recommend a watchful waiting approach. Surgery is typically reserved for cases where the pucker leads to substantial vision loss or distortion that affects daily activities.

2. Potential Risks of Surgery: Any surgical procedure carries risks, including infection, bleeding, and complications that could potentially worsen vision. If the benefits of surgery do not outweigh the risks, it may be prudent to monitor the condition.

3. Natural Progression: Macular puckers can remain stable for long periods. In some cases, they may even resolve on their own, although this is less common. Regular follow-ups allow the ophthalmologist to monitor any changes in the condition.

4. Age and Overall Health: At 69 years old, your mother’s overall health and any comorbid conditions may also influence the decision. If she has other health issues, the risks associated with surgery may be more pronounced.

Regarding your second question about the outcomes of surgery for macular pucker, it is essential to understand that while many patients experience improvement in their visual acuity and reduction in distortion after surgery, results can vary. Some patients may regain better vision, while others may only see modest improvements. Factors influencing the surgical outcome include:
- Duration of the Pucker: The longer the macular pucker has been present, the more challenging it may be to restore vision fully. Chronic cases may lead to more significant retinal changes that could affect recovery.

- Pre-existing Conditions: If there are other underlying retinal issues, such as age-related macular degeneration or diabetic retinopathy, these can impact the success of the surgery.

- Surgical Technique and Experience: The skill and experience of the surgeon play a critical role in the outcome. Advanced techniques and technology can lead to better results.

In conclusion, the decision to treat a macular pucker surgically is based on a careful assessment of symptoms, risks, and potential benefits. Your mother's case appears to be stable, and the current recommendation is to continue monitoring her condition. If her vision changes or worsens, she should consult her ophthalmologist to discuss the possibility of surgical intervention. Regular follow-ups are essential to ensure that any changes are promptly addressed.

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