Abstract
Purpose :
The study explores risk factors that are associated with increase severity of retinopathy patients with Sickle Cell Disease.
Methods :
Retrospective Chart Review included patients with a diagnosis of Sickle cell with fluorescein angiogram done at the Henkind Eye Institute at Montefiore Medical Center between October 2012 and August 2018. Patient’s angiograms were divided into 4 groups of increasing severe retinopathy, (1) no ischemia, (2) non-proliferative ischemia, (3) proliferative retinopathy with resolution post laserpexy, and (4) patients with recurrence of proliferative retinopathy post laserpexy. Groups 1 and 2 were compared to groups 3 and 4 to compare nonproliferative retinal ischemia to proliferative ischemia. EMR (EPIC) was used to collect data which included; Hgb S levels, LDH levels, Bilirubin levels, Hydroxyurea dosage, BMI, comorbid ocular and systematic diseases, medical management, and secondary manifestations of Sickle Cell Disease. Chi Square and multivariate ANOVA were used to analyze the data.
Results :
61 patients were included in the study; 56 (91.8%) of these patients had some retinal changes, while 43 (71.7%) patients had previous or current proliferative retinopathy . Five (8.2%) of these patients were in group 1 (no ischemia), thirteen (21.3%) were in group 2 (Non-proliferative ischemia), 33 (54.1%) were in group 3 (proliferative retinopathy with resolution post laserpexy) and 10 (16.4%) were in group 4 (patients with recurrence of proliferative retinopathy post laserpexy). Multivariate analysis of hydroxyurea dosage showed that patients with worse retinopathy were on higher doses (p=0.00913). Chi Square analysis did not indicate significant comorbid disorder that correlated with more severe retinopathy.
Conclusions :
Our study showed a higher rate of current or history of Proliferative retinopathy (71.7%), which could be a selection bias for patients getting angiograms. In this population, higher rates of advanced interventions were needed, supporting the notion that severity of disease correlates with more advanced interventions. Patients on higher dosages of hydroxyurea had worse retinopathy SCD. Cardiac disease was the only comorbid condition that showed a trend towards an association with worse disease. Further evaluation with increased sample size may provide more insight to comorbid diseases and their correlation with advanced interventions for SCD-associated ischemia.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.