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Ask your administrator if you think this is wrong. ====== Vitreoretinal Precursors of Retinal Breaks ====== ====Lattice Degeneration==== * Occurs in 8% (6-10%) slightly more than half are unilateral * 0.5-1% will get a retinal detachment * 20-30% of those with rhegmatogenous retinal detachments have lattice * Clinical appearance varies widely * most common is circumferential round, linear or ovoid areas of retinal thinning, often crossed by whitish lines that represent hyalinized retinal vessels * may also have superficial white/yellow flecks, patches of pigmentation, round or linear white patches or craters, small atrophic holes * 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, tractions which may be symptomatic or asymptomatic * 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 2.3% (10/423) eyes * 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% * Tractional retinal tears, asymptomatic 0.7% (3/423 eyes) * none treated and none progressed * Tractional retinal tears, symptomatic 1.2% (5/423 eyes) * 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==== * 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==== * 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:female * 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 "snowflakes" may be present (thought to be muller cell footplates or neurons that once bridged the cavity) * sclerotic retinal vessels can occur in the area * laser will whiten the outer layer ^ Feature ^ Retinoschisis ^ Retinal Detachment ^ | Age | Middle Age to Elderly | Middle Age | | Refractive association | Hyperopia | Myopia | | Symptoms | Usually absent | Acute present, Chronic Absent | | Scotoma | Absolute | Relative | | Vitreous Hemorrhage or Pigment | Absent | Common | | Location | Inferior or Superior Temporal | Acute: usually superior, Chronic: usually inferior | | Texture | Smooth | Acute: Corrugated, Chronic: smooth | | Muller footplates | Common | Absent | | Mobility | Relatively immobile | Acute: often very mobile, Chronic: May be relatively immobile | | Movement with scleral depression | Moves as a single unit | Height decreases | | Color with scleral depression | "White with pressure" may be seen in outer layer | No "White with pressure" | | Breaks | May be present | Present | | Lattice in elevated area | Unlikely | Suggestive | | Retinal pigment epithelium | Normal unless retinal detachment present or regressed | Acute: Normal, Chronic: Atrophy and demarcation lines may be present | | OCT | Splitting of retinal layers | Subretinal fluid | | Effect of laser through retinal break | Uptake through inner layer break | No uptake through full-thickness break | | Natural history | Progression rare or slow | Acute: progressive, Chronic: may be non-progressive or slowly progressive | Adapted from Table 98.1, Ryan's Retina 7th ed, 2023. ====Resources==== - [[https://pubmed.ncbi.nlm.nih.gov/2780007/ |Long-term natural history of lattice degeneration of the Reina. Byer NE. 1986;96(9):1396-401]] - [[https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323722131001189#hl0000667|Ryan's retina, 7th edition, 2023]] - [[https://www.clinicalkey.com/#!/content/book/3-s2.0-B9780323287920000119#hl0000088 |The Retinal Atlas, 2nd edition, 2017]]