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


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


METHODS
We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which includes the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 3 2004) MEDLINE (1966 to July 2004) and EMBASE (1980 to August 2004). 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 Experts in the field were contacted for details of other published and unpublished studies.


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


METHODS
One reviewer 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.


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


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.
Wilkinson
C
C
Department of Ophthalmology, Johns Hopkins University, 6569 North Charles Street, Baltimore, Maryland 21204, USA. cwilkins@gbmc.org
D006801:Humans; D012162:Retinal Degeneration / Q000628:therapy*; D012163:Retinal Detachment / Q000517:prevention & control*; D012167:Retinal Perforations / Q000628:therapy*