Macular Holes, Macular Pucker, and Macular Edema
Flashes and Floaters
The vitreous is the fluid in front of the retina which helps shape the roundness of the eye. As we get older, the vitreous fluid thickens and degenerates, separating into strings that create floaters. These vitreous floaters are normal, and they float in the remaining vitreous, moving with gravity. When they cast a shadow on the retina, we see them. As we get used to them, however, we don’t notice them as much. The vitreous is attached to the retina in several places. As it changes in consistency, it can tug on the retina, causing traction. The retina registers this as an object, and we see a flash of light. The traction may also pull on a piece of retina and cause a hole or tear, or it can cause a cyst to form in the center of the macula. It can also pull the entire vitreous away from the retina, causing a total vitreous detachment.
Causes of Macular Holes and Macular Pucker
Macular holes and macular pucker have similar origins. Currently, the most widely accepted theory is that vitreal shrinkage causes a hole formation. As traction increases, the tugging at the fovea causes a separation of the sensory retina from the underlying retinal pigment epithelial cells. Ultimately, the retina shrinks and forms a tear, and eventually progresses to a full-thickness hole. Macular holes may also result from chronic macular edema, solar retinopathy (excessive exposure to UV light often in areas closer to the equator) and blunt trauma.
Treatment of Macular Holes and Macular Pucker
Vitrectomy surgery may be performed when vision is significantly impaired. Surgery may be done immediately or after a short period of time depending on the cause of the detachment. See Treatment for Retinal Detachment and Retinal Tears for more information.