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. [13, 14, 15]
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. [16] 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
Subclinical retinal detachment (>1-disc diameter of subretinal fluid but < 2-disc diameters posterior to the equator) may be treated more effectively with a scleral buckle approach versus a laser barrier.
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.
Retinal detachment treatments
Frank rhegmatogenous retinal detachment may be treated with a scleral buckling procedure and/or pars plana vitrectomy with gas administration. [17] All areas of lattice and retinal breaks should be meticulously sought after and barricaded with laser or cryotherapy.
Surgical Care
Treatment of rhegmatogenous retinal detachment as described under Medical Care.
Complications
Retinal detachment may still occur after treatment.
Consultations
A retinal surgeon may need to be consulted.
Long-Term Monitoring
Patients with lattice degeneration should undergo annual dilated eye examinations with close attention the peripheral retina.
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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.
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Another example of wicker lines seen within a lattice lesion. Prophylactic retinopexy has been performed around this lesion.
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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.
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A large horseshoe tear at the opposite edge of the lattice lesion pictured above. Laser retinopexy surrounds the tear and lattice lesion.
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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.
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An example of a heavily pigmented lattice lesion.
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An acute rhegmatogenous retinal detachment that may be associated with lattice degeneration. (Lattice lesion not seen in this image.)
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Another example of a peripheral lattice lesion with a snail-track appearance.
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Lattice lesion containing small atrophic holes.
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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.
