|LATTICE DEGENERATION WITH AND WITHOUT ATROPHIC HOLES
Lattice degeneration occurs in eight to 11 percent of the general population. It presents as a linear trail of fibrosed vessels within atrophied retina in a "lattice" pattern. It nearly always runs circumferentially between the equator and the ora serrata. The individual lesions are usually from one-half to six disc diameters and may run 360 degrees around the eye in a discontinuous pattern. There may be associated RPE hyperplasia, giving the lesion a pigmented appearance. Atrophic holes are often present in the lesion, occasionally large enough to encompass the entire lattice lesion. The incidence of atrophic holes in lattice degeneration ranges from 18 to 42 percent. A tractional linear tear will occur on the posterior edge of lattice lesions in 1.9 percent of lesions. Lattice degeneration is typically bilateral.
The retinal thinning has several effects: (1) the overlying vitreous will be disturbed, resulting in a pocket of liquefaction overlying the lattice lesion known as a lacuna; (2) the vitreous along the edges of the lattice lesion will undergo strong adhesion to the retina; and (3) the ischemia and retinal thinning will disturb the retinal pigment epithelium, resulting in RPE hyperplasia and a pigmented appearance.
Often the thinning becomes so profound that a full-thickness hole atrophies through the retina at the lattice lesion. The overlying liquefied vitreous has the ability to pass through the hole into the subretinal space and possibly lead to rhegmatogenous retinal detachment. This will occur in approximately two percent of cases of holes within lattice degeneration. Due to the liquefaction of the overlying vitreous, there is no vitreoretinal traction on the edges of a hole in lattice degeneration. If a posterior vitreous detachment occurs, the vitreoretinal traction along the posterior edge of a lattice lesion may result in a linear tear, with an ensuing progression to rhegmatogenous retinal detachment in 37 percent of cases.
Furthermore, prophylactic treatment of lattice lesions in eyes with greater than 6.00D of myopia yields no benefit. These lesions need only routine, yearly monitoring with the patient educated about signs and symptoms of retinal detachment. However, a linear tractional tear forming at the posterior border of a lattice lesion has about a 37 percent risk of progression to retinal detachment and therefore should receive prophylactic therapy.
Other reports in this section
Eyelids & Eyelashes | Conjunctiva & Sclera | Cornea
Uvea | Vitreous & Retina | Optic Nerve & Brain | Oculosystemic Disease
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