Lattice Degeneration

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Contents

Disease

Lattice Degeneration

Etiology

Lattice degeneration is a common clinical entity which has many morphologies. It is defined to have one or more of the following features organized in accordance to their presumed frequency of occurrence: localized round, oval or linear shaped retinal thinning; pigmentation; whitish-yellow surface flecks; round, oval or linear white patches; round, oval or linear red craters; small atrophic round holes; branching white lines; yellow atrophic spots (depigmentation of pigment epithelium); and rarely tractional tears at the ends or posterior margins of lesions. Usually one, but sometimes two or more of these features predominate in each individual lesion.
The observation of lesions in the peripheral retina suggestive of lattice must be carefully examined with scleral indentation and indirect ophthalmoscopy. The borders of lattice lesions will have an abrupt, discrete edge adjacent to otherwise normal retina.
Examples of various lattice lesions are shown below.[1]

Risk Factors

While there are no know risk factors for lattice, it is most commonly found as an incidental finding on routine ophthalmologic exams. Lattice may be found in symptomatic patients in association with retina tears or holes.

General Pathology

Post-mortem histology studies of lattice lesions have shown that there are three invariable findings in all types of lattice:

  1. Retinal thinning.
  2. Vitreous liquefaction overlying the thinned retina
  3. Vitreous condensation and exaggerated vitreo-retinal attachments at the borders of the lesion.[2]

Electron microscopy of lesions shows thinning with fibrosis of blood vessels, loss of neurons, accumulation of glial material, pigment changes, and changes to the inner limiting lamina.[2] It has also been shown that there is a lack of basement membrane over the surface of lattice lesions and replacement with astrocytes.[3]

Pathophysiology

While lattice lesions alone are not symptomatic in themselves, they do lend to a higher risk of holes, tears, and detachments that may become symptomatic. This is thought to occur at the junction of normal retina and lesions where there is observed vitreous traction leading to eventual tear or detachment.

Primary prevention

There are no preventative measures to the development of lattice.

Diagnosis

This is a clinical diagnosis based on history and clinical exam, including slit lamp and dilated fundus examination with sclera depression.

History

Patients with lattice degeneration generally are asymptomatic. They may present for other ocular findings causing their symptoms such as a tear or detachment where there is found to be lattice. It is approximated that there is an overall incidence of lattice in 10% of the general population and the long term chance of retinal detachment in this population to be 0.5%1 On the other hand, one-third of patients with retinal detachments, without compounding factors such as surgery or other conditions, have been reported to have lattice.[4] Therefore, it is recommended to be considerate of patients with lattice and other risk factor for detachment such as surgery or high myopia.

Physical examination

A full ophthalmic exam is necessary for the purposes of identifying lattice lesions and differentiating them from holes, tears, or other pathologic findings.

Signs

Lattice in itself is asymptomatic but may be associated with retinal tears, detachements, or traction that may present with photopsias, floaters, or visual disturbances.

Symptoms

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Clinical diagnosis

Lattice is diagnosed with a dilated direct and indirect ophthalmic exam with the use of sclera depression.

Diagnostic procedures

Lattice degeneration is most often found on routine ophthalmic exam and delineated from other peripheral lesions with scleral depression.

Laboratory test

No laboratory tests are indicated.

Differential diagnosis

The clinical appearance of lattice is variable and may present with multiple morphologies in the same patient. The most common lesions are mentioned and pictured above. Other conditions to consider which may appear similar in appearance include retinoschisis, atrophic holes, chorioretinal scarring, congenital hypertrophy of the retinal pigment epithelium, and most importantly retinal holes/tears/detachments.

Management

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General treatment

There is no mandatory treatment for lattice degeneration alone. While it is associated with retinal holes, tears and detachments, it is not advocated to treat lattice lesions on a solely prophylactic basis.


When they are associated with retinal holes, tears or detachments, then the treatment of those conditions may dictate the course of action for lattice lesions. Below is a chart which describes the general treatment practice patterns. [5]

Medical therapy

There is currently no medical therapy required for this condition.

Medical follow up

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Surgery

Laserpexy is the preferred treatment for lattice lesions at risk for retinal tears/detachment. Based on the risk for future tears or detachments, practitioners may decide to treat with other modalities such as cryotherapy or scleral buckling depending on their assessment of retinal detachment risk.

Surgical follow up

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Complications

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Prognosis

The prognosis for lattice degeneration in itself is good. The vast majority of patients will have lesions that are completely stable or slowly progressive. Patients who develop to retinal tears, detachments, and subsequent vitreo-retinal traction should be treated as those conditions arise.

Additional Resources

http://www.aao.org/

References

  1. Byer NE. Lattice degeneration of the retina. Surv Ophthalmol. Jan-Feb 1979;23(4):213-48.
  2. 2.0 2.1 Straatsma BR, Zeegen PD, Foos RY, et al: Lattice degeneration of the retina. Trans Am Acad Ophthalmol Otolaryngol 78:87-113, 1974.
  3. Streeten BW, Bert M: The retinal surface in lattice degeneration of the retina. Am J Ophthalmol 74:1201-1209, 1972.
  4. Burton TC: The influence of refractive erro and lattice degeneration on the incidence of retinal detachment. Trans Am Ophthalmol Soc. 87: 143-157, 1989.
  5. Wilkinson, CP: Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration. Ophthalmology: 107: 12-15, 2000.


Original article contributed by: Tim Inchul Kim, MD
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