Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration PPP 2019

By the American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee: Christina J. Flaxel, MD,¹ Ron A. Adelman, MD, MPH, MBA, FACS,² Jennifer I. Lim, MD,³ Steven T. Bailey, MD,⁴ Amani Fawzi, MD,⁵ G. Atma Vemulakonda, MD,⁶ Gui-shuang Ying, MD, PhD⁷

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¹Casey Eye Institute, Oregon Health & Science University, Portland, OR

²Yale University Eye Center, New Haven, CT

³University of Illinois at Chicago, Chicago, IL

⁴Casey Eye Institute, Oregon Health & Science University, Portland, OR

⁵Feinberg School of Medicine, Northwestern University, Chicago, IL 

⁶Department of Ophthalmology, Palo Alto Medical Foundation, Palo Alto, CA

⁷Center for Preventative Ophthalmology and Biostatistics, Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA

Highlighted Findings and Recommendations for Care

Acute horseshoe retinal tears and traumatic breaks usually require treatment.

Asymptomatic atrophic or operculated retinal breaks rarely need treatment. More generally, an eye that has atrophic round holes within lattice lesions, has minimal subretinal fluid without progression, or lacks evidence of posterior vitreous detachment (PVD) does not require treatment.

An early diagnosis of a retinal detachment is important because the rate of successful retinal reattachment is higher and the visual results are better when repaired early, especially before the rhegmatogenous retinal detachment (RRD) involves the macula.

Lattice degeneration is present in 6% to 8% of the population and increases the risk of retinal detachment.

Patients presenting with an acute PVD and no retinal breaks have a small chance (~2%) of developing retinal breaks in the weeks that follow. Selected patients, particularly those with any degree of vitreous pigment, vitreous or retinal hemorrhage, or visible vitreoretinal traction, should be asked to return for a second examination promptly if they have new symptoms or within 6 weeks following the onset of PVD symptoms.

Between 5% and 14% of patients found to have an initial retinal break will develop additional breaks during long-term follow-up. Cataract surgery is a risk factor for new retinal breaks.

Treatment of peripheral horseshoe tears should extend to the ora serrata if the tear cannot be surrounded using laser or cryotherapy. The most common cause of failure is inadequate treatment, particularly along the anterior border (where visualization is more difficult).

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