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Justin Nguyen, Kenneth M Yee, Christianne A Wa, Alfredo A Sadun, J Sebag; Macular Pucker Lowers Contrast Sensitivity which Improves After Surgery. Invest. Ophthalmol. Vis. Sci. 2014;55(13):313.
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© ARVO (1962-2015); The Authors (2016-present)
Macular pucker may reduce contrast sensitivity by altering inner retinal function. Interference with incident light by the detached posterior vitreous cortex as a result of posterior vitreous detachment (PVD) and the premacular membrane may further reduce contrast sensitivity. It is thus hypothesized that patients with macular pucker will have lower contrast sensitivity compared to controls and that this will improve following vitrectomy with membrane peeling.
A total of 23 eyes were studied. B-scan ultrasonography (Aviso, Quantel, France) was performed in 16 eyes of 8 patients (5 females, 3 males; 71 ± 12 years) with unilateral macular pucker. Contrast sensitivity was measured prospectively in the 8 eyes of these 8 patients with clinically significant macular pucker. Findings were compared to the fellow eyes as well as to 7 eyes of 7 age-matched controls (4 females, 3 males; 66 ± 4 years) using Freiburg acuity contrast testing [Weber index: %W = (Maximum Luminance - Minimum Luminance) / Maximum Luminance] performed at a spatial frequency of 5 cpd. The lower the Weber index, the better the contrast sensitivity. Sutureless 25 Gauge vitrectomy with membrane peeling was performed without chromodissection in the macular pucker eyes by one surgeon (JS).
All (8/8; 100%) macular pucker eyes had PVD with a detached posterior vitreous cortex detected by ultrasound. Average pre-operative contrast sensitivity in patients with macular pucker was 6.41 ± 2.11 %W, which was significantly worse than age-matched controls (2.96 ± 1.82 %W; P<0.012), and the fellow eyes (3.55 ± 2.14 %W; P<0.03). Contrast sensitivity improved at 1 week (4.03 ± 1.99 %W; P=0.05) and 1 month (3.63 ± 1.76 %W; P<0.04) post-operatively to levels essentially the same as the normal fellow eyes.
Following PVD, macular pucker and the presence of a detached posterior vitreous cortex as well as a premacular membrane are associated with decreased contrast sensitivity when compared to the fellow eye and age-matched controls. Contrast sensitivity improves after vitrectomy with membrane peeling, suggesting that contrast sensitivity may be a useful index of disease severity and the response to surgical therapy for macular pucker.
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