Proliferative Sickle Cell Retinopathy: Outcomes of Vitreoretinal Surgery

Abstract

Purpose : To report the clinical presentation and outcomes in patients who underwent surgery for proliferative sickle cell retinopathy (PSCR).

Methods : Retrospective case series of all patients who underwent vitreoretinal surgery for complications secondary to PSCR between 1/1/2014 and 12/31/2021 at a university referral center.

Results : The study included 65 eyes of 61 patients. Disease distribution included 24 (44.4%) eyes with SC disease, 14 (25.9%) with SS disease, 13 (24.1%) with sickle cell trait, and 3 (5.6%) with sickle cell-beta thalassemia. Preoperative transfusion was not performed in any study patients. Regional anesthesia with monitored anesthesia care (RA-MAC) was utilized in 58 (89.2%) eyes and general anesthesia in 7 (10.8%). In eyes that underwent surgery for retinal detachment (RD; N = 52) the rate of single operation anatomic success was 72.4% with combined scleral buckling/pars plana vitrectomy (SB/PPV; N = 29) compared to 47.8% with PPV alone (N = 23; P = 0.07). Mean BCVA at the last follow-up examination was 1.27 (20/372) in the SB/PPV group and 1.05 (20/226) in the PPV group (P = 0.48). In all SB cases, an encircling band was utilized and there were no known cases of anterior segment ischemia. All eyes that had surgery for VH (N = 13) underwent PPV with endolaser treatment and mean BCVA improved from 1.67 (20/944) preoperatively to 0.45 (20/56) at last follow-up examination (P < 0.001). Mean preoperative BCVA, type of RD, indication for surgery, single operation anatomic success rate, and mean BCVA at last follow-up examination did not differ based on sickle cell disease type (P > 0.05).

Conclusions : In patients with RD, SB/PPV achieved slightly higher rates of single operation anatomic success compared to PPV alone. Visual acuity outcomes were similar in the 2 groups. The majority of patients received RA-MAC anesthesia and preoperative transfusions were not performed. There were no cases of postoperative anterior segment ischemia. SC disease was the most common disease type in the current study and surgical outcomes did not differ between sickle cell disease types.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.