What is Macular Pucker?

Macular pucker affects approximately 10 percent of people, particularly men and women over the age of 50. Based in the center of your retina, the macula is responsible for the part of your vision that allows you to see straight ahead. As you read the text on this page, you are using your macula. When the retinal surface forms an extra layer of tissue and contracts, distorting the retina, it is known as a macular pucker. They look like a piece of scotch tape and can distort the central vision. If you start to notice this, you should see a doctor for macular pucker as soon as possible.

What is Age-Related Macular Degeneration (AMD)?

Age-Related Macular Degeneration (AMD) is a disease, which causes visual loss in patients over the age of 50. The vision loss is painless, usually gradual and not severe, but can be variable among patients. Macular degeneration is named for the macula, the part of the retina responsible for central vision. Peripheral vision is usually not affected by macular degeneration and often, this illness will go unnoticed until a patient engages in a task such as driving or reading, in which central vision is crucial. As the term “degeneration” implies, the illness becomes more noticeable over time and tends to get worse with or without treatment. Macular degeneration typically affects adults over 65 and the main risk factors for the disease are increasing age and genetics (family history of macular degeneration). Smoking, high cholesterol and hypertension are also risk factors. This disease does not cause total blindness and most macular degeneration patients can see well enough to care for themselves.

What is Retinal Tear and Retinal Detachment?

Retinal detachment is treatable when caught early. Treatment may or may not involve an in or outpatient surgical procedure. In cases that do require surgery, a patient may require immediate attention or the procedure may be postponed for days or even weeks depending on the condition’s severity. Two major retinal detachment surgeries include: Vitrectomy: In this procedure, the surgeon removes the vitreous jelly, which has pulled on the retina and caused retinal detachment. Usually, the doctor then replaces the fluid with a gas bubble, which the eye, in time, will absorb and replace with its natural fluids. Doctors may recommend this surgery in instances where:

What is Diabetic Retinopathy?

Diabetic retinopathy is a condition where high blood sugars damage the blood vessels in the retina (the retina is the layer of cells in the back of the eye that transmit light to the brain to form images). There are two main types of diabetic retinopathy: non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).

What is Retinal Vein Occlusion (RVO) and Macular Edema?

The retina is the light-sensing layer of cells that lines the inner wall of the back of the eye. The retina converts light into signals that are sent to the brain where they are recognized as images. What is Retinal Vein Occlusion? Your retinas require a rich supply of oxygenated blood. This blood is carried to the retina from the heart through arteries, while veins carry deoxygenated blood from the retina back to the heart via the optic nerves. The arteries that transport oxygen to your retina may stiffen and thicken over the years, especially in people with diabetes, cardiovascular disease, high blood pressure and high cholesterol. The retinal arteries and veins are close to the optic nerve and cross various locations on the retina’s surface. As arteries thicken, they can compress the retinal vein at artery-vein crossing points or in the optic nerve. This compression can be so severe that the veins become constricted and thus blood flow to the heart is reduced. The blood then backs up into the retina not unlike the water in a clogged bathtub. The pressure of blood in the veins causes swelling (called macular edema) and bleeding in the retina.

California Traction Retinal Detachment

Board-certified retina surgeons with more than 23 years of clinical experience diagnosing and surgically treating tractional retinal detachments for patients throughout California.

When diabetes or other conditions cause scar tissue to grow on the surface of your retina, that tissue can tighten over time and pull the retina away from its normal position. This is called a tractional retinal detachment, and it’s a fundamentally different problem than the more common detachment caused by a retinal tear. The retina isn’t torn. It’s tethered. The scar tissue gripping the surface has to be carefully dissected away during surgery, which makes these cases more complex than a standard detachment repair.

At Retina Associates of Orange County, we receive referrals for traction retinal detachment in California from general ophthalmologists, optometrists, and endocrinologists throughout Southern California and the surrounding region. Our physicians are fellowship-trained vitreoretinal surgeons, board-certified by the American Board of Ophthalmology, with over two decades of surgical experience. We operate out of offices in Laguna Hills, Newport Beach, CA, and Santa Ana.

Vitreoretinal Surgeons for Tractional Detachment in California

In a rhegmatogenous detachment, a tear or hole in the retina allows fluid to slip underneath and peel it away from the eye wall. In a tractional detachment, the mechanism is entirely mechanical. Scar tissue or fibrovascular proliferation on the retinal surface contracts and physically pulls the retina out of position. There is no tear involved, at least not initially. The most common cause, by a significant margin, is proliferative diabetic retinopathy.

This distinction matters because the surgical approach is different. A tractional detachment often involves dense adhesions between scar tissue and the retina, and the surgeon must carefully dissect and segment those membranes without creating new tears. The procedure demands a high degree of precision, specialized instrumentation, and experience managing complications that can arise when the retina is both detached and tethered. That’s the kind of surgery our California retina surgeons perform regularly.

Retina Services We Offer in California

Tractional retinal detachment rarely exists in isolation. Patients who develop this condition almost always have underlying retinal disease, and many have additional conditions requiring concurrent or staged treatment. Our practice manages the full spectrum of vitreoretinal pathology.

Tractional retinal detachment. Caused by fibrovascular scar tissue pulling on the retina, most often in the setting of proliferative diabetic retinopathy. We perform complex vitrectomy surgery to relieve traction, remove membranes, and reattach the retina using laser, gas, or silicone oil tamponade as needed.
Diabetic retinopathy (all stages). From non-proliferative changes like microaneurysms and cotton-wool spots to advanced proliferative disease with vitreous hemorrhage and neovascularization. We use pan-retinal photocoagulation, anti-VEGF injections, and vitrectomy to manage diabetic retinopathy at every stage.
Retinal tears and detachments. Rhegmatogenous detachments caused by retinal tears are treated with laser retinopexy, cryotherapy, pneumatic retinopexy, scleral buckling, or vitrectomy, depending on the location and severity.
Macular edema. Diabetic macular edema is one of the most common complications we treat alongside tractional detachment. Fluid buildup in the macula is managed with anti-VEGF agents and corticosteroid implants.
Epiretinal membrane. Epiretinal membrane is a fibrous membrane on the macular surface that distorts central vision. Treated with vitrectomy and membrane peeling when symptoms affect daily function.
Macular degeneration. Both dry and wet forms of age-related macular degeneration, including anti-VEGF injection therapy and treatments for geographic atrophy.
Retinal vein occlusion. Venous blockages in the retina cause sudden vision loss and swelling. We manage retinal vein occlusion with intravitreal injections and monitor for complications like neovascularization that could lead to tractional changes.
Macular hole. A macular hole is a full-thickness defect in the central retina that typically requires vitrectomy with gas tamponade for closure.

Why Choose Retina Associates of Orange County for Traction Retinal Detachment in California?

Vitreoretinal Surgical Volume and Complexity

Not every retina practice regularly operates on tractional detachments. These are among the most technically demanding procedures in vitreoretinal surgery. The scar tissue is often intimately adherent to the retina, and a single inadvertent tear during dissection can convert a tractional detachment into a combined tractional-rhegmatogenous detachment, which significantly changes the prognosis.

Dr. John C. Hwang brings a careful, methodical technique to complex vitreoretinal cases. Dr. Mrinali Gupta is known among patients for thorough explanations and compassionate follow-through, and she manages a high volume of diabetic retinal disease. Dr. Desmond Edward McGuire completed his retina fellowship at UC San Diego’s Shiley Eye Center after training at Columbia University in New York and holds memberships in the American Society of Retina Specialists and the American Academy of Ophthalmology.

Coordinated Care for Diabetic Patients

Because tractional retinal detachment is overwhelmingly linked to diabetes, our approach extends beyond the operating room. We work closely with referring endocrinologists and primary care physicians to coordinate care. Uncontrolled blood sugar accelerates retinal damage. Hemoglobin A1c levels, blood pressure management, and kidney function all factor into surgical planning and recovery. Our clinical trial participation through the Retina Associates Research Institute also gives diabetic patients potential access to emerging therapies that may slow disease progression or improve surgical outcomes.

We see patients at multiple offices across Orange County, CA, including Laguna Hills, Newport Beach, and Santa Ana.

Understanding Tractional Retinal Detachment Care

Conditions We Treat and Treatment Options

Tractional retinal detachment develops when proliferative tissue on the surface of the retina contracts with enough force to separate the retina from the underlying retinal pigment epithelium. According to the National Eye Institute, the most common cause is diabetic retinopathy, which damages retinal blood vessels and triggers scar formation as the disease advances to its proliferative stage.

The CDC reports that approximately 40 million Americans have diabetes. Among those, diabetic retinopathy is the leading cause of vision loss, and a percentage of those patients will progress to tractional detachment if proliferative disease is not treated in time.

Key characteristics and symptoms of tractional detachment include:

Gradual, painless loss of vision (unlike the sudden onset of rhegmatogenous detachment)
Blurred or distorted central vision when the macula is involved
Floaters or visual obscuration from associated vitreous hemorrhage
Often discovered during routine dilated eye exams before symptoms appear
History of poorly controlled diabetes or longstanding diabetic retinopathy

Surgical treatment is pars plana vitrectomy, which involves removing the vitreous gel and carefully dissecting the fibrovascular membranes from the retinal surface. In some cases, endolaser is applied during surgery to treat areas of active neovascularization. Tamponade agents such as gas bubbles or silicone oil may be used to hold the retina flat during healing. Silicone oil, when used, requires a second procedure for removal after the retina has stabilized.

Not every tractional detachment requires immediate surgery. If the detachment is peripheral and does not threaten the macula, close monitoring with frequent imaging may be appropriate. But when traction involves or threatens the macula, surgical intervention is typically recommended promptly to preserve central vision.

What to Expect from a Tractional Detachment Evaluation

A thorough review of your diabetes history, including current A1c, medications, and any previous retinal treatment
Dilated fundus examination with assessment of the extent and location of tractional membranes
Optical coherence tomography and widefield imaging to map retinal anatomy and identify macular involvement
Fluorescein angiography if neovascularization or areas of retinal non-perfusion need to be characterized
A detailed surgical plan discussion, including timing, risks, tamponade options, and postoperative positioning requirements

Typical Treatment Timeline

Referral and initial evaluation: Many tractional detachments are identified during diabetic eye screening. Once referred, we evaluate urgency based on macular involvement and rate of progression.
Pre-surgical optimization: If time permits, we may recommend improved glycemic control before surgery. Severe hyperglycemia increases bleeding risk and complicates healing. Anti-VEGF injection may be given days before surgery to reduce neovascularization.
Surgical repair: Vitrectomy with membrane dissection is typically performed as an outpatient procedure. Surgery length varies depending on the complexity of the tractional membranes. Cases involving dense adhesions or combined tractional-rhegmatogenous detachment may take longer.
Postoperative recovery: Patients with gas tamponade may need face-down positioning for days to weeks. Silicone oil cases involve activity restrictions but typically no specific positioning. Follow-up visits are frequent in the first month.
Long-term management: Even after successful surgery, diabetic patients require ongoing retinal monitoring because the underlying disease can cause recurrent traction, new hemorrhage, or macular edema.

Recovery timelines vary significantly based on surgical complexity, tamponade type, macular status, and the patient’s overall metabolic health.

What to Bring to Your First Visit

Insurance card and photo ID
A complete list of current medications, especially insulin, oral diabetes drugs, and blood thinners
Your most recent hemoglobin A1c result and any relevant lab work
Prior OCT scans, fundus photographs, or angiography from your referring provider
Names and contact information for your endocrinologist or primary care physician

Plan for a longer appointment. The evaluation for tractional detachment involves multiple imaging studies and a thorough surgical discussion.

California Ophthalmology and Diabetes Resources

Patients in California can access these public resources for credential verification and reliable health information:

Medical Board of California — verify the license status of any physician or surgeon practicing in the state
National Eye Institute — federal resource covering the types and causes of retinal detachment, including tractional detachment
CDC Diabetes Statistics — national data on diabetes prevalence, complications, and prevention
American Academy of Ophthalmology — patient education materials on diabetic eye disease and vitreoretinal surgery

These resources provide general health information and are not a substitute for evaluation by a qualified retina surgeon.

Contact Retina Associates of Orange County

If you have been told that scar tissue is pulling on your retina, or that your diabetic retinopathy has advanced to the point where surgical intervention may be necessary, we encourage you to schedule a consultation. Tractional retinal detachment is a serious condition, and the outcomes are best when it is managed by a surgeon who operates on these cases routinely.

Our retina surgeons see patients at our Laguna Hills, Newport Beach, CA, and Santa Ana offices. We accept most major insurance plans and coordinate benefits verification before your appointment.

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