Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment

Wilkinson CP

Published Online:

July 8, 2009

A rhegmatogenous retinal detachment develops when a break (tear, hole) occurs in the sensory retina and allows fluid from the vitreous cavity to separate the sensory retina from the underlying retinal pigment epithelium. When retinal breaks occur they may be associated with symptoms such as dark floaters or flashing lights or they may develop without symptoms, in which case they are termed "asymptomatic". Because asymptomatic retinal breaks and lattice degeneration are associated statistically with retinal detachment at variable periods later on, treatment of the lesions with laser or cryotherapy has been proposed to prevent the latter problem. This review discovered no prospective and/or randomized trials comparing treatment and controls, and there is therefore insufficient evidence to demonstrate any benefit of prophylactic therapy for the problems that were studied.

Abstract (click to read)

Background:

Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina in the region of the retinal break, because such symptomatic retinal tears are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these problems is frequently recommended, in spite of the fact that the effectiveness of this therapy is unproven.

Objectives:

The purpose of this review was to evaluate the effectiveness of interventions for asymptomatic retinal breaks and lattice degeneration.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which includes the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library (Issue 4 2008), MEDLINE (1966 to November 2008) and EMBASE (1980 to November 2008). The electronic databases were last searched on 24 November 2008. Textbooks regarding retinal detachment and the reference lists of relevant reports were reviewed for additional study reports. Experts in the field were contacted for details of other published and unpublished studies.

Selection criteria:

This review was designed to include randomized controlled trials in which one treatment for asymptomatic retinal breaks and lattice degeneration was compared to another treatment or to no treatment.

Data collection and analysis:

Initially one author assessed the search results and collected relevant studies. Since no studies met the inclusion criteria, no studies were assessed for methodological quality. No data were extracted and no meta-analysis could be performed.

Main results:

No trials were found that met the inclusion criteria for this review.

Authors' conclusions:

No conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or lattice degeneration. Some current recommendations for treatment, based upon a consensus of expert opinion, are contradicted by the best available evidence.

This record should be cited as:

Wilkinson CP. Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD003170. DOI: 10.1002/14651858.CD003170.pub2

Assessed as up to date:

November 24, 2008

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Primary Review Group:

Eyes and Vision Group

Health topics:

Eyes & vision > Retinal degeneration > Other

Eyes & vision > Retinal disease > Other

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment

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