Macular Pucker Staging System and Surgery

Over the last decade, tremendous advances has been made in the evaluation and surgical management of macular puckerMacular pucker. Macular puckerMacular pucker can be staged according to a 4-stages OCT staging system based on the presence of the ectopic inner foveal layers (EIFL), a continuous layer of inner retinal tissue covering the whole foveal roof, sign of chronic tangential traction. Centripetal traction in macular puckerMacular pucker lead to the formation of EIFL, whether centrifugal traction causes the formation of epiretinal membraneEpiretinal membrane-foveoschisis, an entity previously included in the lamellar macular holeLamellar macular hole spectrum (tractional subtype). Axial traction in macular puckerMacular pucker may cause the abnormalities of the central cone bouquetCone bouquet, an important anatomical landmark particularly susceptible to mechanical stress. The cotton ball sign, the foveolar detachment and the pseudovitelliform lesion are part of the same clinical spectrum and represent different stages of cone bouquetCone bouquet tractional alterations. Macular puckerMacular pucker may cause both exudative and tractional macular edemaMacular edema, the first with petaloid appearance as seen with OCT, the second with a spoke-wheel morphology. Surgery in macular puckerMacular pucker should be tailored to the patient’s characteristics and expectations, but earlier intervention is recommended to avoid the development of irreversible damage. Centripetal peeling may better preserve the integrity of the central foveaCentral fovea.