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| vitreoretinal_precursors_retinal_breaks [2026/02/24 18:28] – Scott Larson | vitreoretinal_precursors_retinal_breaks [2026/02/25 18:26] (current) – Scott Larson | ||
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| ====== Vitreoretinal Precursors of Retinal Breaks ====== | ====== Vitreoretinal Precursors of Retinal Breaks ====== | ||
| - | FIXME | + | |
| ====Lattice Degeneration==== | ====Lattice Degeneration==== | ||
| - | * Occur in 8% | + | * Occurs |
| - | * Slightly more often unilateral | + | * 0.5-1% will get a retinal detachment |
| - | * Byer's natural history study | + | * 20-30% of those with rhegmatogenous retinal detachments have lattice |
| - | * Subclinical retinal detachments 10/423 | + | * Clinical appearance varies widely |
| + | * most common is circumferential round, linear or ovoid areas of retinal thinning, | ||
| + | * may also have superficial white/ | ||
| + | * Histologic appearance usually has one of the three: | ||
| + | * localized thinning of inner retinal layers | ||
| + | * vitreous liquefaction overlying thinned retina | ||
| + | * vitreous condensation with exaggerated vitreoretinal attachments at the margins of the lesion | ||
| + | * Associated with retinal tears, detachments, | ||
| + | * Monitoring recommended if asymptomatic with a consideration for prophylactic treatment in a fellow eye of those with retinal detachment. | ||
| + | ===Byer's natural history study of lattice retinal degeneration (423 eyes)=== | ||
| + | * 276 consecutive patients with average 10.8 years follow-up (1-25 years) | ||
| + | * Subclinical retinal detachments | ||
| + | * 1 disc diameter of subretinal fluid on all sides of the break | ||
| + | * no extension posterior to the equator. | ||
| + | * treatment needed in 1 | ||
| * Atrophic retinal holes 35% | * Atrophic retinal holes 35% | ||
| - | * Treatment needed in 1/423 | + | * Tractional retinal tears, asymptomatic 0.7% (3/423 eyes) |
| + | * none treated and none progressed | ||
| + | * Tractional retinal tears, symptomatic | ||
| + | * all treated | ||
| + | * Retinal detachment 0.7% (3/423 eyes) | ||
| + | * two due to round retinal holes in lattice lesions | ||
| + | * 1 from a symptomatic retinal tear | ||
| + | * Recommendations from this study | ||
| + | * Phakic eyes if asymptomatic should not have prophylactic treatment | ||
| + | * Retinal detachment in the setting of vitreoretinal traction on lattice lesions containing round retinal holes is relatively common in the setting of significant myopia | ||
| ====Cystic Retinal tufts==== | ====Cystic Retinal tufts==== | ||
| + | * May be responsible for 10% of clinical retinal detachments | ||
| + | * associated with small horseshoe-shaped tears in absence of PVD | ||
| + | * Chance of RD is 1/357 | ||
| + | * Prophylactic therapy is not recommended if present but otherwise normal | ||
| ====Degenerative Retinoschesis==== | ====Degenerative Retinoschesis==== | ||
| + | * acquired splitting of the retina layers | ||
| + | * Most are over 50 years | ||
| + | * 1-4% of the population over age 50 | ||
| + | * Bilateral in 85% and equal male: | ||
| + | * associated with hyperopia | ||
| + | * associated with cystoid generation of the peripheral retina | ||
| + | * cyst-like spaces within the retinal layers | ||
| + | * extent 3 mm posterior to ora | ||
| + | * occur in nearly all adults | ||
| + | * typical type- occurs in outer plexiform layer immediately adjacent to the ora | ||
| + | * reticular type- occurs in the nerve fiber layer immediately posterior to typical cystoid degeration | ||
| + | * retinal breaks can occur within the inner layer, outer layer or both but do not necessarily cause retinal detachment | ||
| + | * Inner breaks by themselves don't cause retinal detachment | ||
| + | * Retinal detachments divided into two types | ||
| + | * Outer layer hole without inner layer holes with fluid in the subretinal space | ||
| + | * Breaks in the inner and outer layer with fluid in the subretinal space | ||
| + | * Clinical appearance: | ||
| + | * thin and smooth elevation of peripheral retina | ||
| + | * inferior temporal quadrant in 70%, superior temporal in 30% | ||
| + | * during scleral depression, the entire enclosed structure can be displaced inward | ||
| + | * small white dots " | ||
| + | * sclerotic retinal vessels can occur in the area | ||
| + | * laser will whiten the outer layer | ||
| + | ^ Feature | ||
| + | | Age | Middle Age to Elderly | ||
| + | | Refractive association | ||
| + | | Symptoms | ||
| + | | Scotoma | ||
| + | | Vitreous Hemorrhage or Pigment | ||
| + | | Location | ||
| + | | Texture | ||
| + | | Muller footplates | ||
| + | | Mobility | ||
| + | | Movement with scleral depression | ||
| + | | Color with scleral depression | ||
| + | | Breaks | ||
| + | | Lattice in elevated area | Unlikely | ||
| + | | Retinal pigment epithelium | ||
| + | | OCT | Splitting of retinal layers | ||
| + | | Effect of laser through retinal break | Uptake through inner layer break | No uptake through full-thickness break | | ||
| + | | Natural history | ||
| + | Adapted from Table 98.1, Ryan's Retina 7th ed, 2023. | ||
| ====Resources==== | ====Resources==== | ||
| - | - Byer' | + | - [[https:// |
| - | - [[https:// | + | - [[https:// |
| + | - [[https:// | ||