Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment
Abstract
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 methods
We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled‐trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 28 January 2012. 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 Experts in the field were contacted for details of other published and unpublished studies.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.
PICOs
Plain language summary
Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment
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.
