O. Charfi

Les décollements de rétine rhegmatogènes bilatéraux simultanés. À propos de 7 observations

PURPOSE Simultaneous bilateral rhegmatogenous retinal detachments are rare. The purpose of our study was to examine the incidence, predictive factors, surgical results and prognosis of these retinal detachments. PATIENTS AND METHODS A retrospective analysis of the medical records of 468 consecutive patients, 7-89 years of age (mean, 45.7 years), undergoing surgery for rhegmatogenous retinal detachment between 1993 and 2000. RESULTS During this period, a total of 497 operations for rhegmatogenous retinal detachment were done. Thirty-two patients had bilateral rhegmatogenous retinal detachment. Simultaneous detachments were observed in seven patients (1.5%). In four cases, the diagnosis of retinal detachment was fortuitous. In fact, most patients presented with unilateral symptoms. The mean age (35 years) of patients suffering from simultaneous bilateral rhegmatogenous retinal detachment was younger than that of patients with unilateral or consecutive bilateral retinal detachments. Five patients were myopic. Multiple round retinal holes were the most frequent lesions responsible for retinal detachment. A preoperative proliferative vitreoretinopathy was found in 57% of cases. The retina was reattached in nine cases (81%). CONCLUSION Simultaneous bilateral rhegmatogenous retinal detachment is usually found in relatively young myopic patients with atrophic retinal holes. They are rare but severe because of their frequent association with preoperative proliferative vitreoretinopathy.But Les decollements de retine rhegmatogenes bilateraux simultanes sont rares. Le but de notre etude est d’etudier leur incidence, les facteurs favorisants leur survenue, leurs resultats operatoires et leur pronostic. Patients et methodes Il s’agit d’une etude retrospective portant sur des patients âges de 7 a 89 ans (45,7 ans) operes de decollements de retine rhegmatogenes durant la periode allant de 1993 a l’an 2000. Resultats Durant cette periode 497 interventions pour decollement de retine rhegmatogene ont ete pratiquees. Trente-deux patients avaient un decollement de retine rhegmatogene bilateral dont 7 (1,5 %) etaient simultanes. Dans 4 cas, la decouverte du decollement de retine rhegmatogene bilateral etait fortuite. En effet, la symptomatologie etait le plus souvent unilaterale. L’âge moyen (35 ans) des patients porteurs de decollements de retine rhegmatogenes bilateraux etait inferieur a celui des patients presentant un decollement de retine rhegmatogene unilateral ou bilateralise. Le plus souvent, les trous atrophiques etaient a l’origine du decollement de retine. En preoperatoire, la frequence de la proliferation vitreoretinienne etait de 57 %. La retine a ete reappliquee dans 9 cas sur 11 operes (81 %). Conclusion Les decollements de retine rhegmatogenes bilateraux surviennent le plus souvent chez des sujets jeunes, myopes, porteurs de lesions degeneratives de la peripherie retinienne a type de trous atrophiques. Ils sont rares mais graves car souvent associes a une proliferation vitreoretinienne.