SPOTLIGHT ON Atrophic Retinal Holes

DISEASE

Atrophic retinal holes are round or oval-shaped lesions often existing in the peripheral retina. They are the result of chronic atrophic changes or thinning of the sensory retina without the presence of vitreoretinal adhesions.

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Atrophic retinal hole is a full-thickness break in the retina often present in the peripheral retina. This disease is generally associated with Lattice degeneration.

Symptoms

Most of the patients with atrophic retinal holes have no symptoms. This condition is generally found incidentally on a regular eye examination. If the patient has an associated posterior vitreous detachment, the patient may complain of decreased vision, floaters, and flashes of lights.

Diagnosis

Atrophic retinal holes are present on the periphery of the retina therefore the peripheral fundus examination is important in the evaluation of this disease. During the indirect ophthalmoscopic examination, the ophthalmologist put some pressure on the patient’s sclera.

This technique is called scleral indentation. Through this technique, the examiner will have a better view of the peripheral retina and the retinal holes adjacent to the ora Serrata can be easily diagnosed.

Goldmann’s three-mirror lens also provides a broader view of the peripheral fundus.

Differential Diagnosis

Atrophic retinal holes have a very typical clinical appearance of full-thickness retinal break without the presence of vitreoretinal adhesions. Despite this, there are many other diagnoses that should be considered, that include:

Horseshoe retinal tear is full thickness, U-shaped breaks in the neurosensory retina. They occur secondary to the vitreoretinal traction.
Lattice degeneration is a peripheral retinal degeneration characterized by localized retinal thinning.
Operculated retinal holes are also found in the peripheral retina. They have a cap of retinal tissue pulling forward into the vitreous body where it floats above the hole.
Snail track retinal degeneration is a group of glistening white dots found mainly on the peripheral retina.

MANAGEMENT

As these holes are small and are present in the far peripheral visual field, they are not usually even noticed or require any treatment. According to some studies, prophylactic laser retinopexy should be done in the following cases:

if the subretinal fluid is present there.
in myopic patients, because the chances of retinal detachment are high among these patients.

if the retinal detachment is present in the patient’s fellow eye.

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REFERENCES

Kanski, Jack. Clinical Ophthalmology 5th edition. Butterworth-Heinemann; 2003:359-371
Preferred Practice Patterns: Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration. AAO 2008
Byer N. Subclinical Retinal Detachment Resulting from Asymptomatic Retinal Breaks. Ophthalmology 2001; 108:1499-1504
Gonzales C,Gupta A, Schwartz S,et al.The fellow eye of patients with phakic rhegmatogenous retinal detachment from atrophic holes of lattice degeneration without posterior vitreous detachment. Br J Ophthalmol 2004 88: 1400-1402
Michaelson I. Role of a Distinctive Choroido-retinal Lesion in the Pathogenesis of Retinal Hole: A Clinical and Pathological Report. Br J Ophthalmol 1956 40: 527-535
Sigelman J. Vitreous Base Classification of Retinal Tears: Clinical Application. Surv Ophthalmol 25:59-74, 1980.