Perspective
Peripheral retinal degenerations and the risk of retinal detachment

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Abstract

Purpose

To review the degenerative diseases of the peripheral retina in relationship with the risk to develop a rhegmatogenous retinal detachment and to present recommendations for use in eyes at increased risk of developing a retinal detachment.

Design

Focused literature review and author’s clinical experience.

Results

Retinal degenerations are common lesions involving the peripheral retina, and most of them are clinically insignificant. Lattice degeneration, degenerative retinoschisis, cystic retinal tufts, and, rarely, zonular traction tufts, can result in a rhegmatogenous retinal detachment. Therefore, these lesions have been considered for prophylactic therapy; however, adequate studies have not been performed to date.

Conclusions

Well-designed, prospective, randomized clinical studies are necessary to determine the benefit-risk ratio of prophylactic treatment. In the meantime, the evidence available suggests that most of the peripheral retinal degenerations should not be treated except in rare, high-risk situations.

Section snippets

Lattice degeneration of the retina

Lattice degeneration of the retina was probably first described by Gonin13 and since then, it has been better defined by Straatsma and Allen14 and others.15, 16, 17, 18, 19 It is typically characterized by sharply demarcated, circumferentially oriented, oval or round areas of retinal thinning with overlying vitreous liquefaction and exaggerated vitreoretinal attachments along its edges. Other features that can be, but are not always, present include fine white lines (latticelike) in the

Degenerative retinoschisis

Degenerative retinoschisis was probably first reported by Bartels in 1933.35 Straatsma and Foos36 described two forms based on histopathology, typical or flat retinoschisis, and reticular or bullous retinoschisis. In degenerative retinoschisis, there is a coalescence of cystic lesions as a result of degeneration of neuroretinal and glial supporting elements within areas of peripheral cystoid degeneration. This area enlarges slowly as a substance containing acid mucopolysacharide accumulates.37

Cystic retinal tuft

The retinal lesion that Foos and Allen45 named cystic retinal tuft in 1967 was first illustrated in 1936 by Vogt.46 It is clinically characterized by a round or oval, elevated vitreoretinal lesion which is small, discreet, and sharply circumscribed and has a chalky-white color. Vitreous condensations are attached to its surface, and its base may have pigmentary changes. The lesion occurs most frequently (78%) in the extra basal or equatorial zone of the eye, is single in most cases, and is

Zonular traction tuft

In zonular traction tufts, thickened zonules are displaced posteriorly toward the anterior retina resulting in an anterior projection or tuft of the retina. By histopathology, these lesions show attachments of zonular fibers at the apex of the tuft, neuroglial cells within the tuft, and retinal thickening and degeneration at the base.51

Zonular traction tufts are present at birth and are found in 15% of cases seen at autopsy, being bilateral in 15%. They are mostly single and, in the majority of

Clinical recommendations

Prevention of rhegmatogenous retinal detachment is important because, in many cases, surgical and anatomic success is not followed by visual success. Prophylactic treatment of retinal detachment could be achieved by preventing a posterior vitreous detachment, reducing vitreoretinal traction, or creating a chorioretinal adhesion around precursors of retinal detachment, such as some peripheral retinal degenerations. Unfortunately, we do not know how to prevent vitreous syneresis or posterior

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