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 ciliary body or peripheral chorioretinal atrophy (cobblestone degeneration).

❖ Precursors of retinal detachment such as local thinning of the retina referred 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 ophthalmoscopic examination 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 localized areas of extensive atrophy of the retina, pigment epithelium, and choriocapil-laris that lie between the ora serrata and the equator. Snail track degeneration presents with yellowish, whitish radiant dots consisting of microglia and astrocytes. 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 degeneration and liquefaction of the overlying vitreous body.

Differential diagnosis: The findings are highly characteristic and easily diagnosed 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 laser therapy does not reduce the risk of retinal detachment. Ophthalmoscopic follow-up examinations should be performed at regular intervals.

Prophylaxis: No prophylaxis is possible.

Clinical course and prognosis: The clinical course is usually benign. Round atrophic 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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