BASICS
DESCRIPTION
Lattice degeneration is a common vitreoretinal degeneration associated with retinal thinning, and subsequent retinal tears or detachments.
EPIDEMIOLOGY
Prevalence
• Found in 6–10% of the population
• More common in myopic eyes
• Found in 20% of eyes with retinal detachments (1)
RISK FACTORS
• Myopia
• Family history
• Systemic disorders such as Stickler’s and Wagner’s syndromes
GENERAL PREVENTION
None
PATHOPHYSIOLOGY
Inner retinal atrophy with overlying pockets of liquefied vitreous with adherence of formed vitreous to the borders of the areas of lattice degeneration
ETIOLOGY
Unknown, but there is likely a genetic predisposition.
COMMONLY ASSOCIATED CONDITIONS
• Axial myopia
• Atrophic holes
• Chorioretinal atrophy
• Stickler’s or Wagner’s syndrome
DIAGNOSIS
HISTORY
• Symptoms of vitreous or retinal detachment, such as flashes or floaters
• History of retinal tears or detachments in the fellow eye
• Family history of retinal tears or detachment
• History of myopia (patients may have had laser vision correction or cataract surgery, and should be specifically asked)
PHYSICAL EXAM
• Careful inspection of vitreous for signs of dispersed pigment (indicating tear or detachment)
• Presence of posterior vitreous scleral detachment
• Peripheral retinal exam including depression ophthalmoscopy reveals varied appearance of lattice degeneration:
– Usually there are linear, pigmented lesions, anterior to the equator that parallel the ora serrata.
– Variable retinal thinning
– Sclerotic vessels or white atrophic spots
– Atrophic retinal holes or branching white lines may be present within the patches of lattice degeneration.
DIFFERENTIAL DIAGNOSIS
• Cobblestone degeneration
• Peripheral retinoschisis
• Microcystic degeneration
• Chorioretinal scar
• Previous laser treatment
• Chronic retinal detachment
• Hereditary vitreoretinal degenerations such as Stickler’s syndrome
• Stickler’s syndrome is characterized by mid-face hypoplasia and small chin; bifid uvula or cleft palate; cataract; lattice degeneration; and a high risk of retinal detachment. It is caused by mutations in COL2A1 or in COL11A1 (2,3)
TREATMENT
ADDITIONAL TREATMENT
General Measures
• If no symptoms or tears, then treatment is not indicated even if atrophic holes are present (4,5)[C].
• Consider treating the asymptomatic eye if the fellow eye has had retinal tears or detachment.
• If symptomatic (flashes and/or floaters), consider offering laser demarcation.
• Treat retinal tears with laser or cryoretinopexy.
• Retinal detachments should be treated in a standard fashion.
ONGOING CARE
FOLLOW-UP RECOMMENDATIONS
• Recommended follow-up depends on the extent of lattice, symptoms, and presence of tears or retinal detachments.
• Patients with high myopia and patients with a history of retinal detachment in the fellow eye should be watched closely.
PATIENT EDUCATION
Symptoms of retinal tears should be explained. If new flashes, floaters, or scotoma develop, prompt evaluation is critical.
PROGNOSIS
• For patients with lattice degeneration, the risk of retinal detachment is only 1% over a 10-year period.
• Prognosis is excellent unless retinal detachment develops.
• Delay in treatment of retinal detachment can lead to permanent vision loss.
REFERENCES
1. Benson WE, Morse PH. The prognosis of retinal detachment due to lattice degeneration. Ann Ophthalmol 1978;10:1197–1200.
2. Edwards AO. Clinical features of the congenital vitreoretinopathies. Eye 2008;22:1233–1242.
3. Ang A, Poulson AV, Goodburn SF, et al. Retinal detachment and prophylaxis in type 1 Stickler syndrome. Ophthalmology 2008;115:164–168.
4. Byer NE. Long-term natural history of lattice degeneration of the retina. Ophthalmology 1989;96:1396–1402.
5. Wilkinson CP. Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration. Ophthalmology 2000;107(1):12–15; discussion 15–18.
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