Macular pucker, the vitreomacular
traction syndrome, and impending
macular hole are three idiopathic macular disorders sometimes treated by vitreous surgery. Each condition has distinctive clinical features, pathogenic mechanisms, vitreoretinal anatomy, surgical findings, results, and complications. The clinical and pathologic features of these three conditions are compared based on a series of: (1) 101 idiopathic
macular pucker cases for which clinicopathologic correlation with transmission electron microscopy (
CPC-EM) was available, (2) 24 cases of the vitreomacular
traction syndrome (7 patients with
CPC-EM), and (3) 43 cases of impending
macular hole (7 patients with
CPC-EM). All cases of
macular pucker, 16 cases of vitreomacular
traction syndrome, and 15 cases of impending
macular hole have been reported. The median visual acuity for patients with
epiretinal membrane and vitreomacular
traction syndrome improved from 20/200 preoperatively to 20/70 and 20/50 postoperatively.
Macular holes occurred postoperatively in 11 of 43 patients with impending
macular hole. The three conditions must be differentiated clinically so that proper recommendations regarding prognosis and possible surgical management can be made.