Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration

Publication Date: September 27, 2019

HIGHLIGHTED FINDINGS AND RECOMMENDATIONS FOR CARE

Acute horseshoe retinal tears and traumatic breaks usually require treatment.
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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.
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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.
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Lattice degeneration is present in 6% to 8% of the population and increases the risk of retinal detachment.
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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.
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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. (, , )
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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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Recommendation Grading

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Overview

Title

Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration

Authoring Organization

Publication Month/Year

September 27, 2019

Supplemental Implementation Tools

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Identify patients at risk of developing a rhegmatogenous retinal detachment. Examine symptomatic patients who have an acute PVD to detect and treat associated retinal breaks or tears. Recognize the evolution of retinal breaks and lattice degeneration. Manage patients at high risk of developing retinal detachment. Educate high-risk patients about symptoms of PVD, retinal breaks, and retinal detachments as well as the need for periodic follow-up. Discuss treatment options available for VMT. Recognize the potential side effects of treatment of VMT 
 

Inclusion Criteria

Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Optometrist, nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D012163 - Retinal Detachment, D020255 - Vitreous Detachment

Keywords

vision loss, Posterior Vitreous Detachment, Retinal Breaks, Lattice Degeneration

Source Citation

Flaxel, C. J., Adelman, R. A., Bailey, S. T., Fawzi, A., Lim, J. I., Vemulakonda, G. A., & Ying, G. (2019). Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration Preferred Practice Pattern®. Ophthalmology. doi:10.1016/j.ophtha.2019.09.027

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
112
Literature Search Start Date
April 1, 2018
Literature Search End Date
June 1, 2019