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Area of Science:

  • Ophthalmology and Vision Science
  • Retinal Imaging and Diagnostics
  • Surgical Outcomes Research

Background:

  • Macular pucker (MP) is an epiretinal membrane that can distort the macula, affecting visual function.
  • Quantitative assessment of MP's impact on macular structure and visual performance is crucial for evaluating treatment efficacy.

Purpose of the Study:

  • To measure the effects of macular pucker (MP) on macular structure and visual function, including visual acuity (VA), contrast sensitivity (CS), and visual distortions.
  • To quantitatively evaluate the outcomes of surgical intervention for MP using these functional and structural measures.

Main Methods:

  • A prospective, comparative case series involving 53 patients with unilateral MP and their normal fellow eyes.
  • Diagnostic tools included ultrasound for posterior vitreous detachment and OCT for ellipsoid zone disruption (EZD), macular thickness, and volume.
  • Visual function was assessed using VA (logMAR), CS (%W), and a visual distortions index (%DI) calculated from Amsler grid testing, with comparisons made pre- and post-surgery (1, 3, 6, 12 months).

Main Results:

  • MP eyes exhibited significantly worse structural and functional indices compared to unoperated MP eyes and normal fellow eyes, including increased macular thickness and volume, and reduced VA and CS.
  • Posterior vitreous detachment was more prevalent in MP eyes (90%) than fellow eyes (50%). Ellipsoid zone disruption (EZD) was present in 33% of operated MP eyes pre-surgery and correlated with worse VA and CS.
  • All measured indices improved post-surgery, but only visual distortions (%DI) and macular volume normalized to control levels by 12 months.

Conclusions:

  • Quantitative measures effectively characterize the structural and functional impact of MP.
  • Surgical intervention for MP leads to improvements in VA, CS, and distortions, yet only distortions and macular volume fully normalize.
  • Contrast sensitivity and distortion quantification are valuable objective outcome measures for assessing visual dysfunction in MP and evaluating therapeutic success.