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Facteurs de risque de décollement de rétine de l'oeil adelphe après un premier décollement de rétine : Une étude cas-témoins

It is known that the fellow eye (FE) of patients with previous rhegmatogenous retinal detachment (RD) has a greater risk of developing this disease. Knowing the risk rate would be interesting because it could suggest a prophylactic treatment. Previous studies showed several risk factors such as high myopia, young age, lattice degeneration, giant retinal tear in the first eye and an incomplete posterior vitreous detachment. However, these studies have a short follow-up and none of them include a control group. The aim of this retrospective case control study is to investigate the possible risk factors for rhegmatogenous retinal detachment in the fellow eye (FRD).

Patients who presented a bilateral RD who underwent surgery at the Ophtalmopôle of Cochin were included as cases. Controls were matched to cases if the follow-up duration was equal or superior to the delay for FRD in the case. Data collected were: Age, gender, side, break location and type, FE lattice degeneration, high myopia, posterior vitreous detachment (PVD) at baseline. Exclusion criteria’s were: FRD at baseline, pre-existing RD history, lack of baseline clinical examination and baseline OCT.

100 cases with FRD were screened. 64 were excluded. 36 cases were matched to 72 controls in a 2:1 ratio. Mean age was 54.1 years for the cases and 58,4 for the controls (P=0.141). Male rate was 0.69 for the cases and 0.67 for the controls (P=0.942). Mean follow-up was 40.8 +/- 19.1 months for the cases and 45.6 +/- 18.6 for controls. 83% of the cases had their FRD before the third year. We found that absence of FE PVD at baseline (8.02 [1.76-36.61] P=0.005), high myopia (3.18 [1.28-7.92] P=0.021), superior breaks in the first eye (4.53 [1.25-16.4] P=0.027), presence of lattice degeneration in the fellow eye (3.5 [1.31-9.36]) were risk factors of FRD.

This is the first case control study evaluating risk factor of FRD. We found that the most significant risk factor of FRD is the absence of PVD at baseline in the fellow eye. FRD occurs in 4 to 16% of patients during follow-up. Laser prophylaxis is still very debated in preventing FRD. It’s interest  seems to be little or non-existent after the third year of follow-up but can be discussed in the early post-operative period. 

A new score based on our result could help determine the indication for prophylaxis in the early post-operative period.