Peripheral Retinal Abnormalities
The major peripheral chorioretinal changes associated with pathologic myopia are lattice degeneration, white-without-pressure, pigmentary degeneration, paving stone degeneration, retinal holes, retinal tears, and retinal detachment. Each of these entities
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17
Sarah Mrejen and Michael Engelbert
17.1
Introduction
The major peripheral chorioretinal changes associated with pathologic myopia are lattice degeneration, white-withoutpressure, pigmentary degeneration, paving stone degeneration, retinal holes, retinal tears, and retinal detachment. Each of these entities has a distinct morphology and prevalence varying with age and axial length. They are all prone to progression, although the number and extent of the lattice lesions tend to not progress after the teens. The dynamic interaction between the vitreous and the retina plays an important role in the development, appearance, and progression of these peripheral retinal changes. The combination of abnormal vitreoretinal adhesions, traction upon them by posterior vitreous detachment, and liquefied vitreous gel that can access into retinal breaks is necessary to produce a rhegmatogenous retinal detachment. High myopes have an increased liquid component of the vitreous gel, associated with reduced viscosity and stability [1] and an increased frequency of abnormal vitreoretinal adhesions, whether they are visible, such as lattice degeneration, or invisible leading to retinal breaks. They also have an increased frequency of posterior vitreous detachment at a younger age compared to emmetropic patients [2]. Therefore, high myopes have an increased frequency of rhegmatogenous retinal detachments at a younger age. The recognition of the peripheral retinal changes associated with high myopia through careful ophthalmoscopic examination and possibly additional wide-field retinal imaging is critical because lattice degeneration is frequently
S. Mrejen, MD (*) • M. Engelbert, MD, PhD Vitreoretinal Private Practice, Macula Consultants of New York, 460 Park Avenue, 5th Floor, New York, NY 10022, USA e-mail: [email protected]; [email protected]
associated with retinal breaks and rhegmatogenous retinal detachments while white-without-pressure, paving stone, and pigmentary degeneration are usually benign. Some important peripheral findings are seen in syndromic myopia such as Stickler syndrome as well.
17.2
Lattice Degeneration
Lattice degeneration is acknowledged to be the most important clinically recognizable vitreoretinal abnormality in high pathologic myopia [3]. In 1904, Gonin was the first to describe the histologic appearance of an equatorial lesion consistent with lattice degeneration in an enucleated globe from a patient with retinal detachment [4]. Although it is the least frequent of the major peripheral changes, it is known to be closely associated with retinal breaks and therefore to be a precursor of rhegmatogenous retinal detachment. Even though this entity has been widely described both clinically and histologically, some aspects of the disease remain controversial especially in the area of management.
17.2.1 Historical Background A wide variety of names has been given to lattice degeneration. Gonin gave the first description of lattice degeneration in 1920 and introduced the terms snail-t
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