Lattice Degeneration Treatment & Management
- Author: David Sarraf, MD; Chief Editor: Hampton Roy, Sr, MD more...
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.[12, 13, 14]
- 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 retina. 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 fellow eye lattice lesions.
- Although prophylactic laser treatment may not convincingly prevent subsequent retinal detachment, some authors believe that laser demarcation may limit the extent of future detachments and help preserve the macula.
- 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.
Treatment of rhegmatogenous retinal detachment as described under Medical Care.
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