Vitreoretinal Precursors of Retinal Breaks -CEW

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Occurs in 8%
Slightly more often unilateral
Byer's natural history study (423 eyes)
- Subclinical retinal detachments 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 3/423 eyes
  - none treated and none progressed
- Tractional retinal tears, symptomatic 5/423 eyes
  - all treated
- Retinal detachment 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 a 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

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

Byer's natural history study of lattice degeneration
Ryan's retinal 7th edition 2023