From the Guidelines
Lattice degeneration is a vitreoretinal degenerative process that predisposes to retinal tears and detachment, characterized by retinal thinning, overlying vitreous liquefaction, and firm vitreoretinal adhesions at the margins of thinning 1.
Key Characteristics
- Lattice degeneration is a peripheral vitreoretinal condition that increases the risk of retinal detachment
- It is characterized by retinal thinning, overlying vitreous liquefaction, and firm vitreoretinal adhesions at the margins of thinning
- Most lattice degenerations are ovoid, with the long axes of lattice running parallel to the ora serrata
- Perivascular lattice occurs radially and is typically found adjacent to the retinal vessels
- Radial lattice is associated with a much higher risk of retinal detachment than circumferential lattice
Risk Factors
- Lattice degeneration is present in 6% to 8% of the population and increases the risk of retinal detachment 1
- Perivascular or radial lattice is associated with a higher risk of retinal tear or detachment formation
- Other risk factors for retinal detachment include myopia, cataract or other intraocular surgery, neodymium yttrium-aluminum-garnet (Nd:YAG) laser surgery, trauma, a history of RRD in the other eye, certain genetic disorders such as Stickler syndrome, or family history of retinal detachments in a first-degree relative
Clinical Significance
- Lattice degeneration is a risk factor for developing a rhegmatogenous retinal detachment (RRD) either from round holes without PVD or tractional-related holes associated with PVD 1
- Small asymptomatic peripheral retinal detachments occurring secondary to retinal holes in areas of lattice degeneration are termed subclinical detachments and have a low likelihood of progression in most patients
- Prophylactic or interventional treatment should be considered when the detachments are documented to become symptomatic, increase in size, or show other signs of progression 1
From the Research
Definition and Characteristics of Lattice Degeneration
- Lattice degeneration is considered the most significant peripheral retinal disorder potentially predisposing to retinal breaks and retinal detachment 2
- It affects the vitreous and inner retinal layers with secondary changes as deep as the retinal pigment epithelium and perhaps the choriocapillaris 2
- Lattice degeneration begins early in life and has been reported in sequential generations of the same family, suggesting a possible genetic component 2
- The association between the vitreous and retina in lattice lesions may be responsible for the majority of lattice-induced retinal detachments 2
Clinical Presentation and Epidemiology
- Variations in clinical appearance are common, with lattice lesions favoring the vertical meridians between the equator and the ora serrata 2
- Lattice degeneration is often bilateral and has characteristics of a dystrophy 2
- The epidemiology of lattice degeneration is summarized, with possible precursors to retinal detachment 2, 3
- Lattice degeneration is one of the most common and clinically significant peripheral retinal findings 4
Imaging Techniques and Diagnosis
- Ultra-wide field imaging provides reliable color fundus capturing for the primary diagnosis of lattice degeneration and may also be used as a screening tool 4
- Wide-field imaging can be used for targeted documentation of lattice lesions using true colors and with minimal optical distortions 4
- Peripheral structural optical coherence tomography (OCT) or scanning laser ophthalmoscopy in retro-mode can provide information on the status of the vitreoretinal interface, including detection of retinal holes, detachments, and vitreous tractions 4
- Fundus autofluorescence can provide details on atrophic changes, but the risk of retinal detachment by means of this technique requires further investigation 4
Management and Treatment
- The management of lattice degeneration is still a topic of debate, with some studies suggesting that most peripheral retinal degenerations should not be treated except in rare, high-risk situations 3
- Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment, but the effectiveness of this therapy is unproven 5
- No trials were found that met the inclusion criteria for a review of interventions for asymptomatic retinal breaks and lattice degeneration, and no conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks or lattice degeneration 5