Vitreoretinal Precursors of Retinal Breaks

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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.

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