Introduction
Background
Lattice degeneration is a common, atrophic disease of the peripheral retina characterized by oval or linear patches of retinal thinning. The prevalence peaks by the second decade and is believed to be minimally progressive but may be uncommonly complicated by retinal detachment.
Pathophysiology
The pathogenesis of lattice degeneration is not well understood, although several theories have been proposed. Regional developmental absence of the internal limiting membrane versus abnormal vitreoretinal traction dynamics appears to be the most cogent argument proposed.Frequency
United States
Lattice degeneration affects approximately 10% of the population and is bilateral in 30-50% of patients who are affected. A variable familial risk may be present on the basis of various autosomal dominant pedigrees. An increased prevalence exists in myopic eyes, and its prevalence may be associated with increasing axial length, reaching 15% in the longest eyes.
International
No information is available regarding the international occurrence of lattice degeneration.
Mortality/Morbidity
See discussion of retinal detachment in History and Physical.
Race
No reported racial differences exist in lattice degeneration.
Sex
No reported sex differences exist in lattice degeneration.
Age
See History regarding early onset and progression with age.
Clinical
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.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.
- 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.
- 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.
- Various pigmentary disturbances occur in more than 80% of lattice lesions. White-yellow flecks, similar to that seen with degenerative retinoschisis, are an additional common associated feature.
- Atrophic retinal holes and tractional retinal tears may complicate lattice degeneration and increase the risk of retinal detachment.
- 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.
- 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.
- 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 is associated with as many as 40% of all rhegmatogenous retinal detachments.
- 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.
- These patients are predominantly older than 50 years, and only 40% of such eyes are myopic.
- An acute posterior vitreous detachment complicated by retinal tear formation usually is signaled by the complaint of new-onset floaters and/or flashes and the presence of preretinal or vitreous hemorrhage. Patients with these complaints constitute a true ophthalmologic emergency and need urgent ophthalmic examination.
- Tractional lattice-related 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 in lattice degeneration.
- Seventy percent occur in patients younger than 40 years, and 70% of these detachments occur in myopic eyes.
- The posterior hyaloid gel usually is attached excluding a tractional 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.
Causes
See Pathophysiology.
More on Lattice Degeneration |
 Overview: Lattice Degeneration |
| Differential Diagnoses & Workup: Lattice Degeneration |
| Treatment & Medication: Lattice Degeneration |
| Follow-up: Lattice Degeneration |
| Multimedia: Lattice Degeneration |
| References |
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References
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Edwards AO, Robertson JE Jr. Hereditary vitreoretinal degenerations. In: Ryan SJ, ed. Retina. 3rd ed. St Louis, Mo: Mosby;. 2001: 482-98.
Folk JC, Arrindell EL, Klugman MR. The fellow eye of patients with phakic lattice retinal detachment. Ophthalmology. Jan 1989;96(1):72-9. [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 phakic rhegmatogenous retinal detachment from atrophic holes of lattice degeneration without posterior vitreous detachment. Br J Ophthalmol. Nov 2004;88(11):1400-2. [Medline].
Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. Am J Ophthalmol. Jul 2003;136(1):155-60. [Medline].
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].
Wilkinson C. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev. 2005;CD003170. [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].
Further Reading
Keywords
snail-track degeneration, palisades, etat givre, radial perivascular chorioretinal degeneration, equatorial degeneration, Milky way–like degeneration, vitreous base excavation
