Photocoagulation in proliferative sickle retinopathy: results of a 5-year study

The progress of proliferative sickle retinopathy (PSR) in 57 eyes treated by xenon arc photocoagulation has been compared with that in 41 comparison eyes. Angiographic assessment of the treated PSR lesions in 54 patients followed up for a mean period of 47 months (range 8-65 months) revealed cessation of leakage in 44 (81%), reduction of leakage in 8 (15%), and no change in 2 (4%). In the 41 comparison eyes more extensive perfused PSR occurred in 25 (60%), no change in 8 (20), and spontaneous improvement in 8 (20%). Autoinfarction of PSR lesions in comparison eyes was observed during the study period in 16 (39%). Assessed by visual acuity, there was no significant difference between treatment and comparison groups, deterioration of 3 lines or more on the Snellen chart occurring in 9% of the treated eyes and 5% of the comparison eyes. Vitreous haemorrhages occurred in 8 (14%) of treated eyes and in 7 (17%) of the comparison group. The most common complication of photocoagulation was choroidal neovascularisation in the burn area, choroidoretinal neovascularisation (CRN) occurring in 19 patients and choroidovitreal neovascularisation (CVN) in 12 patients. In 4 of the latter patients CVN lesions underwent rapid growth and in 4 were associated with vitreous haemorrhages. Other complications in the treated eyes included transient partial third nerve palsies, preretinal haemorrhage, haemorrhage confined to the burn area, vitreous haemorrhage, vitreoretinal traction, and retinal detachment. Statistical limitations of the present study dictate that the results be interpreted with caution. However, the complications of therapy, and the high prevalence of autoinfarction in the comparison eyes, indicate the need for a properly randomised study to define the role, if any, of photocoagulation in the therapy of proliferative sickle retinopathy.