Proliferative Sickle Cell Retinopathy: Outcomes of Vitreoretinal Surgery

Area of Science:

• Ophthalmology
• Retinal Surgery
• Sickle Cell Disease

Background:

• Proliferative sickle cell retinopathy (PSCR) is a sight-threatening complication of sickle cell disease.
• Vitreoretinal surgery is employed to manage PSCR complications, including retinal detachment and vitreous hemorrhage.
• Understanding surgical outcomes is crucial for managing patients with PSCR.

Purpose of the Study:

• To report the clinical presentation and surgical outcomes in patients with proliferative sickle cell retinopathy (PSCR).
• To compare the efficacy of different surgical techniques for PSCR complications.
• To evaluate the safety and effectiveness of regional anesthesia in PSCR surgery.

Main Methods:

• Retrospective, consecutive case series of 61 patients (65 eyes) undergoing vitreoretinal surgery for PSCR between 2014 and 2021.
• Surgical procedures included combined scleral buckling/pars plana vitrectomy (SB/PPV) and pars plana vitrectomy (PPV) alone.
• Main outcome measures were best-corrected visual acuity (BCVA) and single operation anatomic success rate.

Main Results:

• For retinal detachment (RD), SB/PPV achieved 72.4% anatomic success versus 47.8% with PPV alone (P=0.07).
• Mean BCVA was similar between SB/PPV (1.27) and PPV alone (1.05) groups postoperatively.
• For vitreous hemorrhage, PPV with endolaser improved BCVA significantly (P < 0.001).
• Hemoglobin SC disease was most common; outcomes did not differ by sickle cell disease type.

Conclusions:

• SB/PPV demonstrated a trend towards higher single operation anatomic success for RD compared to PPV alone.
• Visual acuity outcomes were comparable between the two surgical approaches for RD.
• Regional anesthesia with monitored anesthesia care (RA-MAC) was frequently used, and no cases of anterior segment ischemia were reported.
• Surgical outcomes for PSCR were consistent across different types of sickle cell disease.