Evidence-based analysis of prophylactic treatment of asymptomatic retinal breaks and lattice degeneration.
OBJECTIVE
To assess the quality of information in the literature regarding the benefits of prophylactic treatment of asymptomatic retinal tears and lattice degeneration.


CONCLUSIONS
Asymptomatic retinal breaks occur in approximately 7% of patients over age 40, and lattice degeneration is present in approximately 8% of the general population. Because retinal breaks cause retinal detachment and lattice degeneration is associated with approximately 30% of retinal detachments, prophylactic treatment of these lesions has sometimes been recommended.


METHODS
A panel of vitreoretinal experts performed a literature review of all publications regarding prevention of retinal detachment that have been published in English. These articles were then used to prepare recommendations for patient care in an American Academy of Ophthalmology Preferred Practice Pattern (PPP). Each recommendation was rated according to: (1) its importance in the care process and (2) the strength of evidence supporting the given recommendation.


RESULTS
Most recommendations were rated as A (most important to patient care). Only a single publication was graded as I (providing strong evidence in support of a recommendation), and this was not a prospective trial. Of the few publications rated as II (substantial evidence), most were studies documenting a lack of treatment benefit. Because of an absence of level I and level II studies in the literature, level III (consensus of expert opinion) was the basis for most recommendations in the PPP.


CONCLUSIONS
The current literature regarding prevention of retinal detachment does not provide sufficient information to support strongly prophylactic treatment of lesions other than symptomatic flap tears. Prospective randomized trials of prophylactic therapy are indicated. Eyes highly predisposed to retinal detachment should be considered for such studies.
Wilkinson
C P
CP
Department of Ophthalmology, The Greater Baltimore Medical Center and The Johns Hopkins Hospital, Maryland, USA. cwilkins@gbmc.org
D000328:Adult; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D019317:Evidence-Based Medicine; D006801:Humans; D053685:Laser Therapy; D015201:Meta-Analysis as Topic; D017410:Practice Guidelines as Topic; D012162:Retinal Degeneration / Q000150:complications / Q000601:surgery*; D012163:Retinal Detachment / Q000209:etiology / Q000517:prevention & control*; D012167:Retinal Perforations / Q000150:complications / Q000601:surgery*; D014821:Vitrectomy; D020255:Vitreous Detachment / Q000601:surgery