Vitreous surgery for macular pucker.

Vitreous surgery techniques can be used to remove epiretinal tissue associated with various ocular conditions when this tissue covers, distorts, or detaches the macula and causes visual loss. Because the postoperative visual acuity is often between 6/9 (20/30) and 6/30 (20/100), we usually operate on eyes with preoperative visual acuities of 6/30 (20/100) or worse. Thick membranes are easiest to remove, perhaps because the tissue can be more readily engaged by a vitreoretinal pick and because the membrane does not shred when traction is applied. We achieved visual improvement in 45 (90%) of 50 consecutive eyes but no eye achieved a visual acuity of 6/6 (20/20). Postoperative visual acuities ranged from 6/7.5 (20/25) to 6/12 (20/40) in 14 eyes (28%), from 6/15 (20/50) to 6/30 (20/100) in 26 eyes (52%), and from 6/60 (20/200) to 6/120 (20/400) in ten eyes (20%). Peripheral retinal tears were the most frequent intraoperative complication, and should be identified and treated at the end of the operation. Later retinal detachment requiring further surgery occurred in four eyes. No posterior retinal tears occurred in this series. Progressive lens opacities occurred postoperatively in some cases. Twelve (36%) of 33 phakic eyes showed progressive nuclear sclerotic lens changes after vitrectomy. Sizable amounts of epiretinal tissue recurred in two eyes.