Although lattice degeneration (Fig 11-12) may be a familial condition, it is found in up to 10% of the general population. Retinal detachment develops in only a small number of individuals with lattice degeneration; on the other hand, lattice degeneration is seen in up to 40% of all patients with rhegmatogenous detachments.
The most important histologic features of lattice degeneration are
discontinuity of the internal limiting membrane (ILM) of the retina
an overlying pocket of liquefied vitreous
focal sclerosis of retinal vessels, which remain physiologically patent
condensation and adherence of vitreous at the margins of the lesion
variable degrees of atrophy of the inner layers of the retina
Radial perivascular lattice degeneration has the same histologic features as typical lattice degeneration, but it occurs more posteriorly along the course of retinal vessels.
Although atrophic holes often develop in the center of the lattice lesion, they are rarely the cause of retinal detachment because the vitreous is liquefied over the surface of the lattice, preventing vitreous traction. Instead, retinal detachment is generally the result of vitreous adhesion at the margins of lattice degeneration, leading to retinal tears in this location when vitreous detachment occurs. With time, other degenerative changes occur.
Figure 11-12 Retinal lattice degeneration. A, Lattice degeneration appears clinically as prominent sclerotic vessels (arrows) in a wicker or lattice pattern. B, The vitreous directly over the lattice degeneration is liquefied (asterisk), but formed vitreous remains adherent at the margins (arrowheads) of the degenerated area. The internal limiting membrane is discontinuous, and the inner retinal layers are atrophic.
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.