What Is a Macular Pucker?

Macular disease, long-term smoking or passive smoking, smoke stimulation can cause senile macular retinopathy, and eventually blindness, but its pathogenesis has not been known. Once lesions appear in the macular area, vision loss, dark shadows in front of the eyes, or deformed vision often occur. Macular disease can be caused by hereditary lesions, senile changes, inflammatory lesions, and can also be affected by other fundus lesions.

Macular disease

Macular disease, long-term smoking or passive smoking, smoke stimulation can cause senile macular retinopathy, and eventually blindness, but its pathogenesis has not been known. Once lesions appear in the macular area, vision loss, dark shadows in front of the eyes, or deformed vision often occur. Macular disease can be caused by hereditary lesions, senile changes, inflammatory lesions, and can also be affected by other fundus lesions.

Macular disease description

The macula is located at 0.35cm and slightly below the temporal side of the optic nerve disk. It is rich in lutein and has a yellow area called the macula. The depression in the center of the macula is called the fovea, and is the place where vision is most acute.

Macular disease clinical manifestations

There are several common types of macular disease:

1. Central serous choroidal retinopathy: It is more common in men aged 20 to 45 years and usually manifests as a self-limiting disease. It is characterized by dark shadows in front of the eyes, deformed vision, such as smaller and farther; vision loss, but often not less than 0.5, can be partially corrected with convex lens. There is a round reflective wheel at the base of the eye. The center is dark red and the light reflection disappears. There may be gray-white subretinal fibrin deposition. Under the binocular indirect ophthalmoscope, the macula appears as a dome-shaped discoid detached area. In fluorescent angiography, there are one or several fluorescein leakage points in the macula during the venous phase, which gradually show a spray-like or ink-like pattern and expand into a strong fluorescent spot.

2. Age-related macular degeneration: It is a common blinding eye disease in developed areas over 50 years old. As society ages, the incidence increases. Divided into two types of dry and wet. May be related to long-term chronic light damage, genetics, metabolism, nutrition and other factors of the macula.

Third, macular cystoid edema: not a separate disease, often caused by other lesions. The pathological feature is that intraretinal edema contains a honeycomb-like cyst. FFA showed that the edema came from the retinal capillaries with abnormal permeability around the fovea, showing most of the small leakage points, and the accumulation of fluorescence in the cystic cavity, which formed a petal shape due to the radial arrangement of Henle fibers. Appears as vision loss or vision deformation, or symptoms are not obvious. Concave light reflection in the fundus examination disappeared, and the macular retinal reflection enhanced with frosted glass. Sometimes it is difficult to judge under ophthalmoscope. Under the trinocular lens, cystic changes in the retina were occasionally seen. FFA can be diagnosed.

Fourth, macular and pigmented epithelial malnutrition: mainly manifested by yellow matter deposits in the macula and RPE, and gradual loss of cells.

Five, macular hole: can be caused by trauma, degeneration, long-term CME, high myopia, vitreous traction and so on. The fundus showed a dark red hole with a size of 1/2 to 1/4 PD and a clear border, and the bottom of the hole may have yellow particles. Central vision decreased significantly. Macular holes in highly myopic eyes have a great chance of retinal detachment. Retinal detachment surgery or vitreous surgery is required.

6. Macular preretinal membrane: It occurs on the inner surface of the retina and is a fibrotic membrane formed by the migration and proliferation of retinal glial cells and RPE. Can occur in a variety of lesions. The macular ERM formed after retinal detachment is thick and grayish white, which affects vision. Can also be found in RVO, chronic CME, intraocular inflammation, retinal pigment degeneration and other fundus diseases, eye trauma and photocoagulation, condensation after surgery. The shrinkage of the membrane can cause wrinkles and deformation of the macula, macular edema, causing vision loss and deformation of vision. When the ERM is thick and covers the fovea, and the vision is significantly reduced or deformed, vitreous surgery can be used to remove the anterior membrane.

Macular pathological etiology

Age-related macular degeneration is divided into dry and wet types. It is related to long-term macular light damage, genetics, metabolism, nutrition and other factors.

Macular examination diagnosis

Macular cystoid edema: sometimes judged under ophthalmoscope. Under the trinocular lens, cystic changes in the retina were occasionally seen. FFA can be diagnosed.

Macular disease treatment

Macular hole: decreased vision. The macular hole in highly myopic eyes is very large for retinal detachment, which requires retinal detachment or vitreous replacement.

Macular pre-retinal membrane: The shrinkage of the membrane can cause the macula to fold and deform, macular edema, causing vision loss and deformation of the visual object. When the ERM is thick and covers the concave, the vision is reduced or deformed, the front membrane can be peeled off with vitreous body.