Lattice Degeneration Clinical Presentation
- Author: David Sarraf, MD; Chief Editor: Hampton Roy Sr, MD more...
History
Patients with lattice degeneration are typically asymptomatic, and the lesions are usually an incidental finding of dilated ophthalmologic examination. A presenting complaint of blurriness in the distance may be the result of myopia, a common association of lattice degeneration. The acute onset of floaters, flashes of light, peripheral field loss, or central vision loss may indicate the presence of a retinal tear or detachment, a complication of lattice lesions.[5]
Physical
- Clinical features
- Lattice degeneration is characterized by oval or linear patches of atrophic retina with a reddish base and is variably located within the equatorial region of the fundus, typically inferotemporal.[2]
- Lesions may be isolated or multifocal, variable in dimension, and usually are oriented concentric or slightly oblique to the ora serrata.
- Condensed vitreous at the margins of the lattice lesions may appear as vitreous opacities and represent regions of increased vitreoretinal adhesion; overlying vitreal opacities alternatively may be explained by glial proliferation.[6]
- Crisscrossing fine white lines that account for the name lattice degeneration are present in roughly only 10% of lesions and most likely represent hyalinized blood vessels; this is shown in the image below.
Example of a lattice lesion containing white crisscrossing wicker lines, which are seen in about 10% of lattice lesions. This lesion is complicated by an extensive retinal tear at the cuff of the lesion. - Various pigmentary disturbances, shown in the image below, occur in more than 80% of lattice lesions. White-yellow occasionally refractile flecks, similar to that seen with degenerative retinoschisis, are an additional common associated feature.
An example of a heavily pigmented lattice lesion. - Atrophic retinal holes, shown in the image below, and tractional retinal tears may complicate lattice degeneration and increase the risk of retinal detachment.
Lattice lesion containing small atrophic holes.
- Clinical variations
- Snail-track degeneration is a morphologic descriptive term for retinal lesions with the same characteristic size, shape, orientation, and location as lattice lesions and is associated with the aforementioned yellowish flecks. Examples of snail-track degeneration are shown in the images below.
A peripheral lattice lesion demonstrating the typical snail-track appearance, with overlying vitreal opacities, which may represent glial proliferations or regions of increased vitreoretinal condensation. 
Another example of a peripheral lattice lesion with a snail-track appearance. - Vitreous base excavations represent lesions of similar shape, size, and orientations as lattice lesions having a uniform reddish base and located within the vitreous base.
- Pigmentary degeneration is a term that most likely represents lattice lesions with prominent but variable pigmentary changes, including clumps of pigment sometimes heavily scattered at the base of lattice lesions and demarcation lines circumscribing cuffs of subretinal fluid.
- When retinal thinning and pigmentary disturbances are found along retinal vessels, these lattice lesions are referred to as radial perivascular chorioretinal degeneration and are classic findings in Wagner and Stickler disease, a familial vitreoretinal degenerative syndrome. An example of this is shown in the image below.
Radial perivascular chorioretinal degeneration with retinal tear at the margin. These lesions run along vessels and may be found in Wagner's and Stickler's disease.
- Snail-track degeneration is a morphologic descriptive term for retinal lesions with the same characteristic size, shape, orientation, and location as lattice lesions and is associated with the aforementioned yellowish flecks. Examples of snail-track degeneration are shown in the images below.
- Clinical examination
- Identification of lattice lesions depends largely upon the experience of the examiner and the method of examination used.
- The most convenient and frequently used method of examination to detect lattice is with binocular indirect ophthalmoscopy with scleral depression (indentation).
- Slit lamp examination with a Goldmann contact lens is used less frequently. This method allows for high magnification of the lattice lesions and the associated vitreoretinal relationships, but evaluation with scleral depression, a critical element of the peripheral examination, becomes technically difficult when using a contact lens.
- Clinical course
- Lattice lesions are believed to develop early in one's lifetime with minimal progression thereafter. Associated features, such as crisscrossing sclerotic vessels, pigmentation, and atrophic retinal holes, may subsequently develop.
- Retinal detachment is a relatively rare complication of lattice degeneration (< 1% of patients with lattice degeneration), but lattice degeneration is associated with as many as 40% of all rhegmatogenous retinal detachments. Lattice degeneration is present in 11% of fellow eyes in patients with rhegmatogenous retinal detachments.[7, 8, 9] Rhegmatogenous retinal detachment is shown in the image below.
An acute rhegmatogenous retinal detachment that may be associated with lattice degeneration. (Lattice lesion not seen in this image.) - Retinal detachments caused by lattice degeneration occur most commonly by a tractional tear at the cuff or posterior margin of the lattice lesion or less commonly by means of an atrophic hole within the zone of lattice.
- Tractional tears located at the margin of lattice account for 55-70% of retinal detachments in lattice degeneration and are the result of a posterior vitreous detachment (PVD).
- These patients are typically older than 50 years, and only 40% of such eyes are myopic.
- An acute PVD complicated by retinal tear formation usually is signaled by the complaint of new-onset floaters and/or flashing lights (referred to as photopsia) and the presence of preretinal or vitreous hemorrhage. Patients with these complaints constitute a true ophthalmologic emergency and need urgent ophthalmic examination.
- PVD-related lattice detachments typically are supertemporal and not associated with demarcation lines. Surgical repair is successful in 90% of such cases.
- Atrophic holes account for 30-45% of retinal detachments associated with lattice degeneration. In another retrospective case-controlled study, 23.6% of patients with retinal detachments had atrophic holes associated with lattice degeneration.[10]
- Seventy percent occur in patients younger than 40 years, and 70% of these detachments occur in myopic eyes. Sixty percent are found in females.
- Fellow eye pathology is found in a significant (96%) portion of these patients. Thus, examination of the fellow eye is important in these cases.
- The posterior hyaloid gel usually is attached excluding a PVD-related mechanism. These detachments are typically inferior, occur slowly, and demonstrate demarcation lines on examination resulting from the slow progressive accumulation of subretinal fluid.
- A 98-100% success rate exists in repairing such detachments with an excellent visual prognosis.
Straatsma BR, Zeegen PD, Foos RY, et al. Lattice degeneration of the retina. XXX Edward Jackson Memorial Lecture. Am J Ophthalmol. May 1974;77(5):619-49. [Medline].
Byer NE. Lattice degeneration of the retina. Surv Ophthalmol. Jan-Feb 1979;23(4):213-48. [Medline].
Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. Am J Ophthalmol. Jul 2003;136(1):155-60. [Medline].
Edwards AO, Robertson JE Jr. Hereditary vitreoretinal degenerations. In: Ryan SJ, ed. Retina. 3rd ed. St. Louis: Mosby; 2001:482-98.
Byer NE. Long-term natural history of lattice degeneration of the retina. Ophthalmology. Sep 1989;96(9):1396-401; discussion 1401-2. [Medline].
Foos RY, Simons KB. Vitreous in lattice degeneration of retina. Ophthalmology. May 1984;91(5):452-7. [Medline].
Gonzales CR, Gupta A, Schwartz SD, Kreiger AE. The fellow eye of patients with rhegmatogenous retinal detachment. Ophthalmology. Mar 2004;111:518-521. [Medline].
Gonzales CR, Gupta A, Schwartz SD, Kreiger AE. The fellow eye of patients with phakic rhegmatogenous retinal detachment from atrophic holes of lattice degeneration without posterior vitreous detachment. Br J Ophthalmol. Nov 2004;88(11):1400-2. [Medline].
Folk JC, Arrindell EL, Klugman MR. The fellow eye of patients with phakic lattice retinal detachment. Ophthalmology. Jan 1989;96(1):72-9. [Medline].
Ung T, Comer MB, Ang AJ, Sheard R, Lee C, Poulson AV, et al. Clinical features and surgical management of retinal detachment secondary to round retinal holes. Eye. Jun 2005;19:665-669. [Medline].
Avitabile T, Bonfiglio V, Reibaldi M, et al. Prophylactic treatment of the fellow eye of patients with retinal detachment: a retrospective study. Graefes Arch Clin Exp Ophthalmol. Mar 2004;242(3):191-6. [Medline].
Wilkinson CP. Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration. Ophthalmology. Jan 2000;107(1):12-5; discussion 15-8. [Medline].
Wilkinson C. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev. 2005;CD003170. [Medline].
Mastropasqua L, Carpineto P, Ciancaglini M, Falconio G, Gallenga PE. Treatment of retinal tears and lattice degenerations in fellow eyes in high risk patients suffering retinal detachment: a prospective study. Br J Ophthalmol. Sep 1999;83:1046-1049. [Medline].
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