Lattice Degeneration Treatment & Management

  • Author: David Sarraf, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 23, 2010
 

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.[11, 12, 13]

  • 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.[14] 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.
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Surgical Care

Treatment of rhegmatogenous retinal detachment as described under Medical Care.

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Contributor Information and Disclosures
Author

David Sarraf, MD  Associate Clinical Professor of Ophthalmology, Retinal Disorders and Ophthalmic Genetics Division, Jules Stein Eye Institute, UCLA Geffen School of Medicine, 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)

Alex Yuan, MD, PhD  EyeSTAR Resident and Postdoctoral Fellow, Department of Ophthalmology, Jules Stein Eye Institute at University of California, Los Angeles

Alex Yuan, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

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.

Specialty Editor Board

V Al Pakalnis, MD, PhD  Professor of Ophthalmology, University of South Carolina School of Medicine; Chief of Ophthalmology, Dorn Veterans Affairs Medical Center

V Al Pakalnis, MD, PhD 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.

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.

Steve Charles, MD  Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine; Adjunct Professor of Ophthalmology, Columbia College of Physicians & Surgeons; Clinical Professor Ophthalmology, Chinese University of Hong Kong

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

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.

References

  1. 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].

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

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

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

  5. Byer NE. Long-term natural history of lattice degeneration of the retina. Ophthalmology. Sep 1989;96(9):1396-401; discussion 1401-2. [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 rhegmatogenous retinal detachment. Ophthalmology. Mar 2004;111:518-521. [Medline].

  8. 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].

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

  10. 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].

  11. 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].

  12. 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].

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

  14. 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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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.
Another example of wicker lines seen within a lattice lesion. Prophylactic retinopexy has been performed around this lesion.
An example of a flap tear at the edge of a lattice lesion and three adjacent holes. This area of lattice degeneration has been barricaded by laser retinopexy.
A large horseshoe tear at the opposite edge of the lattice lesion pictured above. Laser retinopexy surrounds the tear and lattice lesion.
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.
An example of a heavily pigmented lattice lesion.
An acute rhegmatogenous retinal detachment that may be associated with lattice degeneration. (Lattice lesion not seen in this image.)
Another example of a peripheral lattice lesion with a snail-track appearance.
Lattice lesion containing small atrophic holes.
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.
 
 
 
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