Lattice Degeneration

Lattice degeneration is present in about 8% of the general population and occurs in about 40% of eyes with a retinal detachment. It is also known as milkyway-like or galaxy bands, retinal erosion, and vitreous base excavation. It is an important cause of retinal detachments in young people with nearsightedness (myopia).

Lattice-like lesions are frequently found in patients with Marfan syndrome, Stickler syndrome and Ehlers-Danlos syndrome, all of which are associated with an increased risk of retinal detachment.

Typical lattice consists of spindle-shaped areas of retinal thinning, located between the middle (equator) and the most peripheral parts of the vitreous base (towards the front of the eye). This condition is usually bilateral. A characteristic feature is an arborizing network of tiny white lines within the islands. The surface of lattice lesions, unlike that of normally smooth retina, has a roughened appearance. Lattice lesions occur most frequently in the superior and inferior retina. Features that may be seen in lattice include white lines, atrophic holes, pigment changes, and yellow spots.

Lattice degeneration first appears in young patients, usually reaching the maximum incidence during the second decade, after which new lesions occur in less than 1% of affected patients. The condition is bilateral in approximately 42% of cases. White without pressure (WWOP) often occurs along the borders of lattice lesions. Atrophic holes are often associated with the lattice lesions, but usually are not associated with the development of retinal detachment.

Lattice lesions have a well-documented tendency to develop retinal breaks and flap-tears. No complications are encountered in most patients, even in the presence of small holes which are frequently found within islands of lattice. A retinal detachment with atrophic holes may occasionally occur, particularly in young myopes. Vitreoretinal traction is believed to be very important in the development of the retinal tears and detachment associated with lattice.

As one ages, lattice degeneration tends to become more severe over time, and these age-related changes increase the potential for associated retinal breaks. Retinal tractional tears typically develop along the posterior edge of an island of lattice as a result of dynamic traction at the site of an exaggerated vitreoretinal attachment. Occasionally, a small island of lattice is present on the flap of a retinal tear.

It is very important to understand that every patient with lattice degeneration should be educated about the signs and symptoms of retinal detachment. Patients need to understand that delaying the reporting of the sudden appearance of flashes of light, floaters, sparkles of light, or shadows, can seriously increase the risk of permanent vision decrease or loss. Patients should be examined annually with dilation to monitor for change.