Purchase this article with an account.
M. K. Smolek, N. F. Notaroberto; Spontaneous Resolution of Macular Pucker Verified by 3D Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3280.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Visual acuity is significantly reduced by macular pucker (MP), a condition characterized by irregular traction on the retina, which induces distortion to the photoreceptor layer. Typically, patients report that straight lines appear wavy and blurred with poor resolution of fine details. The spontaneous resolution of MP is rare and poorly documented. This report is a first-person account of the time course and resolution of visual deficits due to MP, presented with corresponding 2D and 3D optical coherence tomography (OCT) data.
A Caucasian male, 52 years of age and a -9.75 D myope OS, experienced a retinal tear that was treated by laser photocoagulation and followed for >18 months. At 3 months, a rapid loss of best-spectacle-corrected visual acuity (BSCVA) occurred that was attributed to MP. Progression was documented with entoptic and metamorphopsia drawings, changes in BSCVA and refraction, biomicroscopy, fluorescein angiography, and 2D and 3D optical coherence tomography (OCT).
BSCVA rapidly dropped from 20/20 to 20/70 with the first sign of dark stress lines in the supra-temporal visual field at 3 months. The stress lines spread across the entire macula by month 4 and thereafter changed their appearance daily. The patient also reported at 3 months the irregular appearance of straight-edged features and letters imaged on or near the fovea (metamorphopsia). A sharply demarcated entoptic circular area of poor contrast and dim vision developed by month 4, and corresponded in size and shape to the enclosed lacuna of the original foveal pit as seen with 3D OCT. OS macular thickness was greater than OD based on 2D OCT. Surprisingly, BSCVA improved to 20/50 by 6 months, 20/30 by 12 months, and approached 20/25 by 15 months, although OCT suggested worsening traction and distortion of the retina. At approximately 18 months, the patient reported a spontaneous overnight improvement of vision with greatly diminished metamorphopsia and a BSCVA of 20/20 that continued to improve to include reading 20/15 letters within 2 weeks, but with some minor macular distortion remaining. 3D OCT imaging showed a return to a more typical foveal pit appearance with some residual peripheral MP. Biomicroscopy and entoptic floater motion indicated a more liquefied vitreous over the macula.
Vitreous liquefaction and spontaneous vitreous detachment appear to have resolved visually significant MP. The 3D OCT imaging agreed with the entoptic reports of increased retinal tension during the 18-month period, but the improvement of BSCVA over time was not correlated with macular thinning or with the 3D appearance of retinal distortion prior to the spontaneous resolution of MP.
This PDF is available to Subscribers Only