Peripheral retinal scatter photocoagulation for the treatment of proliferative sickle retinopathy: Is it always indispensable ?

Abstract

Abstract: : Purpose:Long–term follow up of patients enrolled in a prospective clinical trial to compare the retinal scatter photocoagulation and the natural course of the sea fans. Methods: The development of ocular lesions in 101 patients (202 eyes) with sickle cell disease followed up for a period of 1–13 years (between 1990–2003) is described. All the patients were followed each 6 months by a complete ophtalmologic examination including fluorescein angiography (FA) Results: Among this study , there were 64 (63%) patients with homozygotous cell disease (SS) , 33 (32%) with sickle cell haemoglobin C disease (SC), and 5 with sickle cell ß+ thalassemia (Sß+ thal).Mean follow–up was 4 years (range, 1–13 years). Proliferative sickle retinopathy (PSR) was present on initial examination in 38 (19%) of 202 eyes and developed in a further 16 (8%) eyes during the study period. Development of proliferative retinopathy was more common in sickle cell–haemoglobin C (SC) disease (65%). Initially, there were 35 PSR treated ( argon laser) eyes based on fluorescein angiography and clinical examination. Retinal scatter photocoagulation was applied anterior to the sea fans.19 untreated eyes with PSR were followed as control group. Autoinfarcted or spontaneous fibrosis of the sea fans were present during the course of the study in 80% of control eyes and 95% of treated eyes .Five eyes untreated initially were retreated after developing new sea fans. Complications of proliferative sickle cell retinopathy such as vitreous hemorrhage was observed in 4 eyes (2%) with one laser–induced.A retinal detachment was diagnosed in one eye. Conclusions: The retinal scatter photocoagulation is currently the most effective way to control eyes with sea fan neovascularization. Otherwise , this treatment is still a matter of discussion. This findings and our experience suggests that no treatment should be considered in selected patients under regular examination.

Keywords: retina • retinal neovascularization • laser