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| vitreoretinal_precursors_retinal_breaks [2026/02/25 17:12] – [Resources] 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==== | ||
| * Occurs in 8% (6-10%) slightly more than half are unilateral | * Occurs in 8% (6-10%) slightly more than half are unilateral | ||
| Line 14: | Line 14: | ||
| * Associated with retinal tears, detachments, | * Associated with retinal tears, detachments, | ||
| * Monitoring recommended if asymptomatic with a consideration for prophylactic treatment in a fellow eye of those with retinal detachment. | * Monitoring recommended if asymptomatic with a consideration for prophylactic treatment in a fellow eye of those with retinal detachment. | ||
| - | ===Byer' | + | ===Byer' |
| - | * Subclinical retinal detachments 10/423 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 | * 1 disc diameter of subretinal fluid on all sides of the break | ||
| * no extension posterior to the equator. | * no extension posterior to the equator. | ||
| * treatment needed in 1 | * treatment needed in 1 | ||
| * Atrophic retinal holes 35% | * Atrophic retinal holes 35% | ||
| - | * Tractional retinal tears, asymptomatic 3/423 eyes | + | * Tractional retinal tears, asymptomatic |
| * none treated and none progressed | * none treated and none progressed | ||
| - | * Tractional retinal tears, symptomatic 5/423 eyes | + | * Tractional retinal tears, symptomatic |
| * all treated | * all treated | ||
| - | * Retinal detachment 3/423 eyes | + | * Retinal detachment |
| * two due to round retinal holes in lattice lesions | * two due to round retinal holes in lattice lesions | ||
| * 1 from a symptomatic retinal tear | * 1 from a symptomatic retinal tear | ||
| * Recommendations from this study | * Recommendations from this study | ||
| - | * Phakic eyes if asymptomatic should not a prophylactic treatment | + | * 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 | * Retinal detachment in the setting of vitreoretinal traction on lattice lesions containing round retinal holes is relatively common in the setting of significant myopia | ||
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| ====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==== | ||
| - [[https:// | - [[https:// | ||
| - | - [[https:// | + | - [[https:// |
| - | - [[https:// | + | - [[https:// |