eMedicine Specialties > Ophthalmology > Retina

Lattice Degeneration: Treatment & Medication

Author: David Sarraf, MD, Assistant Clinical Professor of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles, Greater Los Angeles Veterans Affairs Healthcare System
Coauthor(s): Stanley M Saulny, MD, Consulting Staff, Department of Ophthalmology, Ophthalmology Associates of the Valley
Contributor Information and Disclosures

Updated: Feb 27, 2007

Treatment

Medical Care

The presence of uncomplicated lattice does not interfere with visual function and does not constitute a high risk for future development of retinal detachment. Prophylactic treatment is clearly indicated only in the context of specific circumstances.

  • Indications for prophylactic treatment
    • Lattice degeneration complicated by tractional tears as the result of an acute, symptomatic posterior vitreous detachment represents a high-risk situation for future retinal detachment and is an urgent indication for laser retinopexy. Lattice and atrophic holes complicated by progressively increasing subretinal fluid represents an additional indication for surgical intervention.
    • The presence of lattice lesions in fellow eyes of patients who have sustained retinal detachment in the first eye may be treated prophylactically. Exceptions may include eyes with greater than 6 clock hours of lattice lesions and eyes with myopia greater than 6 diopters (D). Strong evidence suggests that subsequent retinal detachments may occur as a result of lesions developing in previously healthy retinas. Moreover, laser scars may increase vitreoretinal adhesion and increase the risk of future retinal tears. Therefore, this indication is controversial. In the absence of the aforementioned features, convincing evidence does not exist to clearly indicate prophylactic laser treatment of lattice lesions.
  • Methods of prophylactic treatment
    • Laser photocoagulation is the primary method of prophylactic treatment. Recommended laser settings include the following: green, yellow, or red wavelengths via biomicroscope/contact lens or indirect ophthalmoscope delivery systems, duration of 0.1-0.2 seconds, and spot size of 100-200 micrometers. Apply laser in 3 confluent 360° rings around the lesion. Care should be taken to avoid bare retinal pigment epithelium.
    • Cryotherapy may be a necessary alternative in cases in which significant hemorrhage prevents laser administration.
    • Subclinical retinal detachment (>1 disc diameter of subretinal fluid but <2 disc diameters posterior to the equator) may be treated more effectively with the conservative scleral buckle approach versus a laser barrier.
    • Frank rhegmatogenous retinal detachment may be treated with a scleral buckling procedure and/or pars plana vitrectomy and gas administration. All areas of lattice and retinal breaks should be meticulously sought after and barricaded with laser or cryotherapy.

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

  1. 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].

  2. Byer NE. Long-term natural history of lattice degeneration of the retina. Ophthalmology. Sep 1989;96(9):1396-401; discussion 1401-2. [Medline].

  3. Byer NE. Lattice degeneration of the retina. Surv Ophthalmol. Jan-Feb 1979;23(4):213-48. [Medline].

  4. Edwards AO, Robertson JE Jr. Hereditary vitreoretinal degenerations. In: Ryan SJ, ed. Retina. 3rd ed. St Louis, Mo: Mosby;. 2001: 482-98.

  5. Folk JC, Arrindell EL, Klugman MR. The fellow eye of patients with phakic lattice retinal detachment. Ophthalmology. Jan 1989;96(1):72-9. [Medline].

  6. Foos RY, Simons KB. Vitreous in lattice degeneration of retina. Ophthalmology. May 1984;91(5):452-7. [Medline].

  7. 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].

  8. Lewis H. Peripheral retinal degenerations and the risk of retinal detachment. Am J Ophthalmol. Jul 2003;136(1):155-60. [Medline].

  9. 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].

  10. Wilkinson C. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database Syst Rev. 2005;CD003170. [Medline].

  11. 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].

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Further Reading

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Keywords

snail-track degeneration, palisades, etat givre, radial perivascular chorioretinal degeneration, equatorial degeneration, Milky way–like degeneration, vitreous base excavation

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Contributor Information and Disclosures

Author

David Sarraf, MD, Assistant Clinical Professor of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles, Greater Los Angeles Veterans Affairs Healthcare System
David Sarraf, MD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Coauthor(s)

Stanley M Saulny, MD, Consulting Staff, Department of Ophthalmology, Ophthalmology Associates of the Valley
Stanley M Saulny, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Writers Association, and American Society of Cataract and Refractive Surgery
Disclosure: Nothing to disclose.

Medical Editor

Vytautas A Pakainis, MD, Chief of Ophthalmology, Dorn Veterans Administration Medical Center, Professor of Ophthalmology, Ophthalmology, University of South Carolina School of Medicine
Vytautas A Pakainis, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

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