Elsevier

Ophthalmology

Volume 107, Issue 1, January 2000, Pages 12-15
Ophthalmology

Original Articles
Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration

Presented in part at the annual meeting of the American Ophthalmological Society, Santa Barbara, California, May 1999.
https://doi.org/10.1016/S0161-6420(99)00049-4Get rights and content

Abstract

Purpose

To assess the quality of information in the literature regarding the benefits of prophylactic treatment of asymptomatic retinal tears and lattice degeneration.

Clinical relevance

Asymptomatic retinal breaks occur in approximately 7% of patients over age 40, and lattice degeneration is present in approximately 8% of the general population. Because retinal breaks cause retinal detachment and lattice degeneration is associated with approximately 30% of retinal detachments, prophylactic treatment of these lesions has sometimes been recommended.

Literature reviewed

A panel of vitreoretinal experts performed a literature review of all publications regarding prevention of retinal detachment that have been published in English. These articles were then used to prepare recommendations for patient care in an American Academy of Ophthalmology Preferred Practice Pattern (PPP). Each recommendation was rated according to: (1) its importance in the care process and (2) the strength of evidence supporting the given recommendation.

Results

Most recommendations were rated as A (most important to patient care). Only a single publication was graded as I (providing strong evidence in support of a recommendation), and this was not a prospective trial. Of the few publications rated as II (substantial evidence), most were studies documenting a lack of treatment benefit. Because of an absence of level I and level II studies in the literature, level III (consensus of expert opinion) was the basis for most recommendations in the PPP.

Conclusions

The current literature regarding prevention of retinal detachment does not provide sufficient information to support strongly prophylactic treatment of lesions other than symptomatic flap tears. Prospective randomized trials of prophylactic therapy are indicated. Eyes highly predisposed to retinal detachment should be considered for such studies.

Section snippets

Methods

With the dedicated assistance of the AAO PPP Retina Panel,3 the author conducted a MEDLINE literature search of articles published in English from 1966 to the present. Search words included retinal detachment, posterior vitreous detachment, lattice degeneration, retinal tear, retinal hole, retinal break, vitreoretinal degeneration, and prophylactic therapy. Additional pertinent articles from a variety of textbooks and older journals had previously been collected by the author.4 These

Results

All recommendations regarding therapy were considered to be level A, most important to the quality of the patients’ care. However, the strength of the evidence used to support the recommendations was surprisingly weak. No prospective randomized clinical trials regarding the prevention of retinal detachment have been published. Of the 25 recommendations regarding treatment that were published in the new PPP,3 a rating of I was applied to a single recommendation for therapy, to treat symptomatic

Discussion

Current management of many posterior segment disorders, including diabetic retinopathy, age-related macular degeneration, and venous occlusive disease, is based on results of prospective randomized collaborative trials. However, our review of the ophthalmologic literature devoted to prevention of retinal detachment revealed that optimal trials regarding prophylactic treatment are unavailable. Prospective randomized trials of therapy to prevent retinal detachment have not been performed. Our

Acknowledgements

The author thanks Dennis Robertson, MD, and the additional members of the AAO PPP Retina Panel: Richard K. Bernstein, MD, FACE, FACN, Michael A. Bloom, MD, Emily Y. Chew, MD, Paul P. Lee, MD, Louis A. Lobes, MD, Flora C. Lum, MD, David W. Parke II, MD, and Marco A. Zarbin, MD, PhD.

References (14)

  • O’Day DM, Steinberg EP, Dickersin K. Systematic literature review for clinical practice guideline development. Trans Am...
  • Hall-Moller J, Albrecht K, Lee P. Conformance with the preferred practice pattern for diabetic eye care. Retina...
  • American Academy of Ophthalmology. Management of posterior vitreous detachment, retinal breaks, and lattice...
  • Wilkinson CP, Rice TA. Michels Retinal Detachment, 2nd ed. St. Louis: Mosby, 1997;1082–117....
  • Shea M, Davis MD, Kamel I. Retinal breaks without detachment, treated and untreated. Mod Probl Ophthalmol...
  • Robertson DM, Norton EWD. Long-term follow-up of treated retinal breaks. Am J Ophthalmol 1973;75:395–404....
  • Verdaguer J, Vaisman M. Treatment of symptomatic retinal breaks. Am J Ophthalmol 1979;87:783–8....
There are more references available in the full text version of this article.

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