Lattice Degeneration

[abhaya]

What would be the ideal treatment for Lattice Degeneration in my left eye with three atrophic holes with no subretinal fluid? I have become overly concerned with the laser treatment of this eye, which was done about month and a half ago when I had only one atrophic hole. Instead of fixing the original problem, it seems to have worsened the left eye problem!

I have mild myopia at -1 diopters with a visual acuity of 20/70.  As a background, I did have a macula on rhematogenous retinal detachment surgery for a boomerang shaped large tear in my right eye, about 4.5 months ago. I still have blurred vision in that eye. Does this detachment in the right eye put me at high risk to have the same in my left eye? Apparently, since the chances seem pretty high, and since one laser attempt in the left eye has only worsened the left eye condition, what is the best solution to this problem?  Would Cryopexy or some other procedure be more helpful, to prevent the retinal detachment in the future?

Any suggestions or ideas to solve this challenge, will be highly appreciated!

[John C Hagan]

You are a much higher risk or RD in the second eye after a RD in the first eye. The laser will not cause new holes, they are generally caused by traction from the vitreous. Both laser and cryotherapy are used to close holes. Not all holes can be reached to treat with freezing and have to be lasered.

If necesssary get a second opinion  even well quaified retina physicians often disagree about which holes should be treated.

JCH III MD

[abhaya]

Dr. Hagan:

Thank you so much for your very helpful response!  Yes, I do have very tough and solid vitreous according to my RD surgeon, almost the type found in children's eyes. My surgeon had to work really very hard to pull it out during the vitrectomy. Obviously, its strong pull created the RD in my right eye, and could possibly casue the same in my left eye, if I don't do something about it.

Doesn't lasering holes put additional stress on the retina, adding more to the pull, thereby accelerating the onset of RD, which I am trying to prevent in the first place? Besides, how lasering of the existing holes prevent constant creation of the new holes caused by the continued vitreous traction, which has already happened once before?  More and more lasering will eventually weaken the retina to a point that it will eventually become predisposed to a major tear, leading to an RD!

Since, the culprit is the vitreous' pull, is there a way to perhaps liquefy the hardened vitreous, so that its traction is subdued, thereby completely eliminating any possibility of any future onset of RD?  If the vitreous can't be liquefied, is there a way to minimize the pull to avoid future holes?  Another approach to avoid holes could be to reinforce the lattice area by filling it up with a silicone or similar filler, to withstand vitreous traction. Are you aware of any such technique?

Your INSTANT feedback has been tremendously helpful and will be, once again, highly appreciated to prevent me from going virtually blind!!

[John C Hagan III, MD, FACS]

1. The laser "welds" or "seals" holes shut. RD begin when the retina tears and fluid goes into the hole and weakens the bond of the retina to the underlying tissue. The scar created by both laser and cryo treatment is very localized and not spread over all the eye. Cryo and laser are not felt to INCREASE the risk of RD but to DECREASE the risk.

2.Time liquifies our vitreous. There is no clinical treatment to make it liquify.

3. There is no treatment to seal holds with glue or silicone that is standard treatment.

Your best bet is to follow your retina surgeon's recommendations and if you are not comfortable with that then to get a second opinion.

JCH III MC

[abhaya]

Dr. Hagan:

Thank you once again for all your INSTANT feedback.  Your responses were extremely timely & helpful to bring clarity in my thought process regarding my eyes. I want to wish you the very best of Happy Holidays, Merry Christmas, and a wonderful Happy New Year 2008!!!

[John C Hagan III, MD, FACS]

Thank you and Merry Christmas to you also.

JCH III MD

[pollyeire]

Hello I have been diagnosed with acute lattice degeneration in both eyes and was told two years ago that i had a one in 500 chance of going blind and to put it to the back of my mind and live my life. Then last summer i had a c section followed four months after by a colonoscopy and since then my eyes became fuzzy with increased floters and flashers. Last week i went to the eye hospital emergency room as i thought i was at risk of an RD and i was told that my eye sight was a time bomb and i may or may not lose it during my life time and there was nothing to be done can you please advise - this is v scary as you can imagine - i am seeing a retina specialist on monday but would also like your advise

[John C Hagan III, MD, FACS]

You will be very re-assured. A chance of going blind of 1 in 500  IS TOTALLY WRONG.  About 5-7% of people have lattice, I personally have lattice. For you to go blind you would have to have a retinal detachment that could not be fixed.The chance of that is remote.  You are probably more at risk for going blind by driving an automobile than having lattice. Just know if you have increase floaters, flashes or loss of peripheral vision see an Eye MD right away.

JCH III MD

[AnnaE]

Please let us hear back fro you after you see the doctor. I also have lattice, and I would like to see you get the best treatment.

[John C Hagan III, MD, FACS]

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[AnnaE]

You have so much knowledge about your condition. This will certainly help you. I knew little when my retina detached for the first time, and I was not allowed to read for 4 months.

I would love to hear how you progress.

Thanks for your posting.

[John C Hagan III, MD, FACS]

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[GAM807]

My husband, 52 yo, WM, with out known risk factors for RD other than PVD suffered a RD in the OD.  This required, vitrectomy, intraorbital Lazer and bubble placement.  He returned 12 weeks post op and was found to have 2 tears OS.  These were in the superior temporal area.  They were treated with op lazer.  What do you know/think of abnormal occular perfusion as the cause of bilateral RD?  Any way to increase the perfusion?  Thanks for your comments.  GAM

[John C Hagan III, MD, FACS]

Poor ocular perfusion can cause problems in the eye but retinal tears and detachments are not due to them. The mechanism of retinal tears and detachments is well understood and is due to vitreous traction causing a tear in the retina then a subsequent retinal detachment.

Poor perfusion can cause: macular degeneration and ischemic maculopathy, choroidal neovacular membranes, worsening of glaucoma.

JCH III MD

[Krish_K]

I am 58, sligtly myopic since my teenage years. A few months ago, an optometrist diagnosed lattice degeneration and this was confirmed by the ophthalmologist and it was bilateral. He did not mention tears or holes and of course, there is no RD and I have good vision. I have had floaters for a number of years and these have not increased.  I have been listed for Argon Laser treatment. I have been looking up lattice degeneration and the overall advice is to have an ophthalmological examination yearly and there is no good evidence that prophylactic laser Rx is indicated and may do harm than good. What would your advice be?
Thank you in anticipation
Krish

[John C Hagan III, MD, FACS]

I would suggest seeing a second ophthalmologist for another opinion about laser RX. Ideally a retina Eye MD specialist.  

JCH MD

[marygr]

I am a 57 year old female with an occasional dry eye problem.  Because of recent floaters, a few zigzags,  and a little blurring at night I had my eyes checked by a retinal specialist.  He found lattice degeneration and because I was leaving the country and could not follow-up he treated me with photocoagulation (lazer).  I am really worried about side effects.  I haven't had a problem and it has been three weeks.

What do I watch for now?  I will not be able to be rechecked until the end of September because I am travelling but reading on the internet is scaring me that other unknown traction problems could happen.  I didn't have time to research the laser before treatment.  Thanks for your help!