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

Review question
We reviewed the evidence about whether treatment of retinal breaks (holes or tears in the retina) and retinal lattice degeneration (thinning and atrophy of retinal tissue) can prevent retinal detachment, a serious vision-threatening problem.

Background
The retina is composed of membraneous layers at the back of the eye. It is the part of the eye that converts visual images into information interpreted by the brain as vision. Sometimes, retinal tissue can tear (known as retinal breaks). The effects of the tearing may cause visual disturbances such as dark floaters or flashing lights. When retinal breaks develop without symptoms, they are termed asymptomatic. Retinal lattice degeneration is a condition associated with retinal breaks in which the retinal tissue breaks down or thins in a lattice pattern.

When a retinal break occurs, fluid from the eye may leak between layers of the retina, specifically between the sensory retina and the retinal pigment epithelium, and cause separation. This separation is known as retinal detachment. Because retinal breaks and lattice degeneration are associated with retinal detachment, treatment of these conditions has been proposed as a way to prevent retinal detachment. Laser therapy or cryotherapy (freezing), or both, are often used with the goal of eliminating the fluid and space between retinal layers.

Results
The author of this review discovered no relevant studies. There is no evidence to demonstrate the effectiveness of prophylactic therapy for asymptomatic tears or holes in the retina. The evidence is current to February 2014.

Authors' conclusions: 

No conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks or lattice degeneration, or both. Current recommendations for treatment, based upon a consensus of expert opinion, should be assessed in a randomized controlled trial.

Read the full 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 lesions frequently is recommended, in spite of the fact that the effectiveness of this therapy is unproven.

Objectives: 

The objective of this review was to assess the effectiveness and safety of techniques used to treat asymptomatic retinal breaks and lattice degeneration for the prevention of retinal detachment.

Search strategy: 

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2014, Issue 2), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to February 2014), EMBASE (January 1980 to February 2014), PubMed (January 1948 to February 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 19 February 2014. Textbooks regarding retinal detachment and the reference lists of relevant reports were reviewed for additional study reports. We contacted experts in the field 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 with another treatment or 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 risk of bias. 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.

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