Abstract
Purpose:
A ten-year long term study was performed to determine the fate of untreated lattice degenerations in high myopic eyes, which has not been reported in the literature before.
Methods:
The clinical features of consecutive high myopia (Spherical equivalent over -6.0diopters) patients enrolled in the High Myopia Clinic of National Taiwan University Hospital were recorded on coded transcription forms, totally 1863 patients were registered and followed regularly. Those found to have lattice degenerations without breaks or retinal detachments and left untreated were collected. All of them are phakic, asymptomatic with no previous ocular diseases. The following data were analyzed: Visual acuity, intraocular pressure, age, sex, refraction error, axial length.
Results:
Among 135 patients and 176 eyes with lattice degenerations without breaks or retinal detachment. Six developed macular-off clinical retinal detachment in the ten-year follow up period that made 4.4% of patients and 3.4% of eyes. Four were male and two were female. The refractive error ranges from -6.0 to -14 diopters, the axial length ranged from 26.5 mm to 31.4mm. Ages ranged from 11 to 52 years old. The average follow up periods were 10.2 years. Three detachments resulted from tractional tears and three from atrophic holes. All six patients were treated successfully by scleral buckling surgery or pars plana vitrectomy. One of them required two surgeries to reattach the retina. Tractional retinal tears were seen in 6 (4.4%) patients and 2.3 % of eyes. Subclinical retinal detachment was seen in 9 (5.1%) of the total 176 eyes, that was 9 (6.6%) of 135 patients. Equatorial diameter measurements were performed during surgery with caliper. Equatorial diameters were found to be larger than axial length in all six clinical retinal detachment eyes.
Conclusions:
Long term study shows a much higher rate of development of rhegmatogenous retinal detachment than those in previous reports in literature in lattice degeneration in normal population (Approximately 4.1 times). Prophylactic photocoagulation is suggested in high myopia patients with lattice degenerations, especially those have an equatorial diameter larger than axial length. The preferred practice pattern guideline suggested by American Academy of Ophthalmology should be reevaluated in high myopic eyes.