Lattice degeneration, a vitreoretinal interface abnormality, is present in 6%–10% of the general population and is bilateral in one-third to one-half of affected patients. It occurs more commonly in—but is not limited to—myopic eyes; a familial predilection is present.
Figure 16-3 Lattice degeneration. A, Color fundus photograph of lattice degeneration as viewed without scleral indentation. Vascular sheathing is apparent where the vessel crosses the area of lattice. Characteristic white lattice lines are visible. B, Color fundus photograph of another example of lattice degeneration demonstrates associated hyperpigmentation, which is commonly observed.
(Part A used with permission from Byer NE. Peripheral Retina in Profile: A Stereoscopic Atlas. Torrance, CA: Criterion Press; 1982.)
Figure 16-4 Fundus photograph of lattice degeneration as viewed with scleral indentation.
(Reproduced with permission from Byer NE. Peripheral Retina in Profile: A Stereoscopic Atlas. Torrance, CA: Criterion Press; 1982.)
Lattice degeneration may predispose eyes to retinal breaks and detachment. The most important histologic features include varying degrees of atrophy and irregularity of the inner layers, an overlying pocket of liquefied vitreous, condensation, and adherence of vitreous at the margin of the lesion (Figs 16-3, 16-4, 16-5).
Lattice degeneration is found in approximately 20%–30% of all eyes that present with rhegmatogenous retinal detachments (discussed later in this chapter). However, because the lattice degeneration is not necessarily causative, prophylactic laser treatment is not universally recommended. When lattice degeneration is the cause of retinal detachment, a tractional tear at the lateral or posterior margin of the lattice lesion or, less commonly, an atrophic hole within the zone of lattice itself occurs (Fig 16-6). Retinal detachments secondary to atrophic holes typically occur in young patients with myopic eyes and no vitreous detachment; they are generally asymptomatic until fixation is involved.
Figure 16-5 Color fundus photograph of lattice degeneration shows a large, posteriorly located flap tear and associated detachment. Note vessel bridging the tear.
(Used with permission from Byer NE. Peripheral Retina in Profile: A Stereoscopic Atlas. Torrance, CA: Criterion Press; 1982.)
Figure 16-6 Lattice degeneration with atrophic hole. A, Fundus photograph of lattice degeneration with a small atrophic hole as viewed with scleral depression. B, Fundus photograph of an example of an atrophic hole as may be observed in lattice degeneration without scleral depression.
(Part A courtesy of Norman E. Byer, MD.)
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.