Visual outcome of treating proliferative sickle cell retinopathy in 108 eyes

Abstract

Aim To report treatment methods and visual outcome of treating proliferative sickle cell retinopathy (PSCR). Design Retrospective interventional. Methods Review of PSCR eyes treated between 2017 to 2022. Patient demographics, fundus findings at presentation, genotype, PSCR stage, treatment used, and visual outcome were assessed. Results 108 eyes of 88 consecutive patients were studied. Male: Female 48:40. Mean age: 38.91 (SD:12.52) years. Genotype: sickle cell haemoglobin C (SC) 83 eyes (76.9%), sickle cell haemoglobin S (SS) 19 eyes (17.6%), and sickle cell trait (AS) 6 eyes (5.5%). PSCR stages: 3: 15 eyes (11.0%), 4: 74 eyes (67.0%), and 5: 19 eyes (22.0%). Treatment methods: Intravitreal Injection (IVI) of anti-vascular endothelial growth factor (VEGF) only (27 eyes,25%), scatter retinal laser photocoagulation (SRLP) only (7 eyes, 6.5%), Vitrectomy + SRLP (29 eyes, 26.9%), IVI + SRLP (25 eyes, 23.1%), and Vitrectomy + IVI + SRLP (20 eyes, 18.5%). The treatment used correlated with PSCR stage (p = 0.000). IVI only was mostly used to treat stage 4 (81.4%), and SRLP only was used for stages 3 (42.9%) and 5 (57.1%). IVI + SRLP treated eyes had the best pre- and post-treatment vision. Vitrectomy + SRLP treated eyes had the most improved vision. SRLP only had least visual improvement. Fundus findings correlated with visual outcome (p = 0.003); but stage of PSCR, genotype and treatment used had no correlation (P > 0.05). Conclusion Several options effectively treat PSCR. Visual outcome improved or remained same in 90.7% of treated eyes. Randomized controlled trials will determine the optimum treatment for each distinct presentation of PSCR. Treatment guidelines and a disease classification system of prognostic value are unmet needs.

Proliferative Sickle Cell Retinopathy: A Patient and a Physician’s Perspective on Quality of Life and Quality of Eye Care

“…In fact, the mean-post-operative BCVA remained below 6/60 and only 23.7% of patients achieved driving vision or better (≥ 6/12). Okonkwo et al [ 32 ] also report poor post-operative outcomes in eyes with tractional retinal detachment with PSCR in their Nigerian series. However, they report maintenance of good vision in eyes with stage 3 PSCR with or without pre-retinal hemorrhage treated with sector laser photocoagulation ± intravitreal anti-VEGF.…”

“…There are no contemporary publications reporting on the proportion of vitreous hemorrhages associated with SCR that clear spontaneously, nor the likelihood and risk factors for progressing to retinal detachment in this scenario. Of note, 72 of 108 eyes (66.7%) from a recent retrospective series of patients with SCR in Lagos, Nigeria received treatment with intravitreal anti-VEGF, vitrectomy and or sector laser photocoagulation for vitreous hemorrhage in isolation and achieved a mean gain of > 5 lines, with a mean follow-up of 21.3 months [ 32 ]. Practice patterns in the US also revealed 16.8% of surgeons use anti-VEGF for vitreous hemorrhage in this context, although there are no randomized controlled trials of anti-VEGF therapy for this indication [ 33 ].…”