Lattice degeneration is a disease of the eye where peripheral retina becomes atrophic in a lattice pattern and may develop tears / breaks / holes, which may further progress to retinal detachment. It is an important cause of retinal detachment in young myopic individuals. The cause is not known but pathology reveals vascular insufficiency resulting in ischemia and fibrosis.

Etiology

• The etiology of lattice is questionable. It appears to be due to dropout of peripheral retinal capillaries with resulting ischemia, which induces thinning of all retinal layers. There is sclerosis of the larger vessels, with their lumen being filled with extracellular glial tissue, giving lattice degeneration its characteristic fibrotic appearance.
• Lattice degeneration occurs in eight to 11 percent of the general population. It presents as a linear trail of fibrosed vessels within atrophied retina in a "lattice" pattern. It nearly always runs circumferentially between the equator and the ora serrata

Ophthalmic features

• Typical lattice consists of sharply demarcated spindle-shaped areas of retinal thinning usually located between the equator of the retina and the posterior border of the vitreous base. This is more frequently located in the temporal half of the retina and is seen more superiorly than inferiorly.
• Atypical lattice is characterised by radial lesions which appear continuous with the peripheral blood vessels. This type is typically seen in patients with Stickler syndrome.

Treatment

• The main concern with lattice degeneration is the chance of progression to rhegmatogenous retinal detachment. With many types of retinal breaks, the area is often prophylactically sealed with laser photocoagulation or cryoretinopexy to prevent this. In lattice degeneration alone, prophylactic treatment is not practical in that the risk of detachment is only 0.1 to 0.7 percent in the phakic eye. Atrophic holes in phakic eyes with lattice degeneration also do not require prophylactic treatment, as the risk of progression to detachment is two percent or less.
• Furthermore, prophylactic treatment of lattice lesions in eyes with greater than 6.00D of myopia yields no benefit. These lesions need only routine, yearly monitoring with the patient educated about signs and symptoms of retinal detachment. However, a linear tractional tear forming at the posterior border of a lattice lesion has about a 37 percent risk of progression to retinal detachment and therefore should receive prophylactic therapy.