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Chapter: Ophthalmology: Retina

Peripheral Retinal Degenerations

Peripheral retinal degenerations refer to degenerative changes that lie parallel to the ora serrata in the peripheral portions of the retina.

Peripheral Retinal Degenerations

Definition

Peripheral retinal degenerations refer to degenerative changes that lie parallel to the ora serrata in the peripheral portions of the retina. These include two basic types:

Harmless retinal changes such as pars plana cysts of the posterior ciliarybody or peripheral chorioretinal atrophy (cobblestone degeneration).

Precursors of retinal detachment such as local thinning of the retinareferred to as snail track or lattice degeneration.

Epidemiology: 

The prevalence of the lesions is 6 – 10%.

Pathogenesis: 

Unknown.

Symptoms: 

Peripheral retinal degenerations are asymptomatic.

Diagnostic considerations: 

The diagnosis is made by ophthalmoscopicexamination of the peripheral retina with the pupil dilated. The retina may be examined by indirect binocular ophthalmoscopy or using a three-mirror lens.

Cobblestone degenerations appear as whitish sharply defined localizedareas of extensive atrophy of the retina, pigment epithelium, and choriocapil-laris that lie between the ora serrata and the equator. Snail track degenera-tion presents with yellowish, whitish radiant dots consisting of microglia andastrocytes. Lattice degeneration presents with thinned retinal areas with whitish sclerotic vessels. This results in reactive focal atrophy and hypertro-

phy of the retinal pigment epithelium in the region of equatorial degenera-tion and liquefaction of the overlying vitreous body.

Differential diagnosis: 

The findings are highly characteristic and easily diag-nosed clinically. Rarely, vascular processes or inflammatory changes and scars from other causes must be considered in a differential diagnosis.

Treatment: 

Treatment is either not required or not recommended as lasertherapy does not reduce the risk of retinal detachment. Ophthalmoscopic fol-low-up examinations should be performed at regular intervals.

Prophylaxis: 

No prophylaxis is possible.

Clinical course and prognosis: 

The clinical course is usually benign. Roundatrophic retinal breaks can develop in the areas of snail track and lattice degeneration. However, the long-term risk of retinal detachment is only 1%.

 

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