FIGURE 1 THE HUMAN EYE WITH MACULAR CENTER OF VISION MARKED BY ARROW ADJACENT TO THE OPTIC NERVE.

FIGURE 2 (A) ABNORMAL GLIAL CELL MEMBRANES (G) ATTACHED TO THE MACULAR SURFACE (I = ILM) BEFORE CONTRACTION (R = RETINA). ANALOGOUS TO A LINE OF MEN HOLDING A ROPE (B).

FIGURE 3 ( C) EMP AFTER CONTRACTION TO PRODUCE MACULAR PUCKER. ANALOGOUS TO A LINE OF MEN SHORTENING A ROPE (D).

Retina Specialist
Dr. Robert Morris
Patient Questions about Macula Surgery; 
Page 1

What is the macula?
The macula is a pinhead-sized part of the retina located at the back of the eye. It is responsible for fine, central vision as compared to course, peripheral vision supplied by the remainder of the retina. It is commonly called the center of vision. (Figure 1).

What types of conditions will need macula surgery?
An estimated 100,000 people in the United States are annually diagnosed with some form of traction maculopathy, commonly known as "macular pucker, wrinkled retina or macular hole." Macular pucker is a wrinkling of the nerve layers of the central retina (macula) in the eye, including the inner thin lining of the retina, called the internal limiting membrane (ILM). The condition is associated with aging and can cause loss of fine vision to the level of legal blindness. Macular pucker and macular hole can also occur after eye surgery for retinal detachment, or as a result of trauma in younger individuals.

These patients who have macular surface scarring, a condition which is distinct from scarring under the retina (a common macular condition known as wet age related macular degeneration), now have access to a variety of surgical techniques that allow surgeons to operate with greater safely and ease to effectively remove this abnormal scarring. The wrinkling is caused by epimacular proliferation (EMP). EMP is formed when scar tissue cells spontaneously grow on the inner surface layer of the macula, for no apparent reason. (Figure 2A and 2B)  By contracting and wrinkling the retina, EMP can cause a person's vision to become distorted and dysfunctional, sometimes leading to the level of legal blindness. (Figure 3C and 3D)  A macular hole with a central blind spot can also develop, partly as a result of surface scarring. Macular hole and macular pucker occur in both eyes 10 to 30% of cases.

How is macula surgery performed?
Following vitrectomy to remove the vitreous and obtain access to the retinal surface, the surgeon must separate the EMP from the retinal surface without damaging the underlying structures that are responsible for vision and yet at the same type completely eliminate all traces of the fragile, wispy adherent membrane. This is accomplished by a manual forceps method in most cases. All macula surgery is performed by viewing the surgical field through a high-powered microscope and vitrectomy is performed in all types of macular surgery for macular membrane removal

Patient Info|PFellowship Program |MaculaSurgery|
RSA Research|RSA Physicians|RSA Location|Resources

Contact us at 205-933-2625 or 800-292-8166
Margaret Harrill - Web Master
rev. Oct 2008

Privacy Practices

This Site Contains Copyrighted Text And Graphics © Copyright 2007 Retina Specialists of Alabama, LLC
Illustrations - © Steve Gordon