![]() In lattice degeneration alone, prophylactic treatment is not practical in that the risk of detachment is only 0.1 to 0.7 percent in the phakic eye. With many types of retinal breaks, the area is often prophylactically sealed with laser photocoagulation or cryoretinopexy to prevent this. The main concern with lattice degeneration is the chance of progression to rhegmatogenous retinal detachment. ![]() If a posterior vitreous detachment occurs, the vitreoretinal traction along the posterior edge of a lattice lesion may result in a linear tear, with an ensuing progression to rhegmatogenous retinal detachment in 37 percent of cases. Due to the liquefaction of the overlying vitreous, there is no vitreoretinal traction on the edges of a hole in lattice degeneration. This will occur in approximately two percent of cases of holes within lattice degeneration. The overlying liquefied vitreous has the ability to pass through the hole into the subretinal space and possibly lead to rhegmatogenous retinal detachment. Often the thinning becomes so profound that a full-thickness hole atrophies through the retina at the lattice lesion. The retinal thinning has several effects: (1) the overlying vitreous will be disturbed, resulting in a pocket of liquefaction overlying the lattice lesion known as a lacuna (2) the vitreous along the edges of the lattice lesion will undergo strong adhesion to the retina and (3) the ischemia and retinal thinning will disturb the retinal pigment epithelium, resulting in RPE hyperplasia and a pigmented appearance. There is sclerosis of the larger vessels, with their lumen being filled with extracellular glial tissue, giving lattice degeneration its characteristic fibrotic appearance. It appears to be due to dropout of peripheral retinal capillaries with resulting ischemia, which induces thinning of all retinal layers. Lattice degeneration is typically bilateral. A tractional linear tear will occur on the posterior edge of lattice lesions in 1.9 percent of lesions. The incidence of atrophic holes in lattice degeneration ranges from 18 to 42 percent. ![]() Atrophic holes are often present in the lesion, occasionally large enough to encompass the entire lattice lesion. There may be associated RPE hyperplasia, giving the lesion a pigmented appearance. The individual lesions are usually from one-half to six disc diameters and may run 360 degrees around the eye in a discontinuous pattern. It nearly always runs circumferentially between the equator and the ora serrata. It presents as a linear trail of fibrosed vessels within atrophied retina in a "lattice" pattern. Lattice degeneration occurs in eight to 11 percent of the general population. There is no racial or sexual predilection. There appears to be a higher incidence of myopia in patients with lattice degeneration. The patient is usually over age 20 and is nearly always asymptomatic, except for possible complaints of flashing lights (photopsia).
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