Anti-VEGF Therapy for Stages 3 and Stage 4 Proliferative Sickle Cell Retinopathy Results in Improved Anatomic and Visual Outcomes

Abstract

Purpose : To investigate the potential utility of intravitreal anti-VEGF therapy for stage 3 or 4 proliferative sickle cell retinopathy (PSR)

Methods : We surveyed the Anti-VEGF versus Laser (ALPS) Group (23 retinal specialists) about experience using anti-VEGF agents in treatment of PSR. Six reported using anti-VEGF treatment for stage 3 and 4 PSR. IRB approval was obtained for a retrospective review of anti-VEGF therapy for PSR. De-identified data collected included baseline demographics (age, sickle cell subtype), ocular history, PSR stage, anti-VEGF therapy parameters, visual and anatomic outcomes (seafan activity and fibrosis, vitreous hemorrhage (VH), development of new seafans or VH) as well as complications (endophthalmitis, retinal tears, tractional (TRD) or rhegmatogenous detachment (RRD)). Only previously non-published cases were included in this series.

Results : There were 38 PSR eyes (US and Nigeria) treated with intravitreal anti-VEGF injections. Five eyes were excluded (4 eyes with diabetic retinopathy and 1 eye with choroidal neovascularization), leaving 33 PSR eyes in 31 patients (22 SC, 6 SS, 1 SThal, 2 unknown); 15 eyes were stage 3 and 18 stage 4 PSR. 10/33 eyes had prior laser photocoagulation for PSR. Anti-VEGF drugs included bevacizumab (24), aflibercept (6) and ranibizumab (3). Treatment regimens included anti-VEGF alone in 13 eyes and anti-VEGF followed by laser photocoagulation (combination) in 20 eyes. Follow-up ranged from 1 to 36 months (4 eyes had only 1 month follow-up). For anti-VEGF alone eyes, seafan regression to inactivity occurred in 9/13 (69%) at both month 1 and last follow-up (3 of 4 persistent seafans were in eyes with 1 month follow-up). For eyes with follow-up > 1 month, at last follow-up, seafans were inactive in 7/8 (87.5%) for anti-VEGF only and 17/20 (85%) for combination eyes (P= NS). For stage 4 eyes, 1-month after anti-VEGF, VA improved > 3 lines in 12/18 eyes, remained stable in 5/18 eyes (all 20/20 or 20/25 at baseline) and worsened in 1/18 eye. For stage 4 eyes with baseline VA 20/40 or worse, 12/13 (92%) improved > 3 lines by month 1 post-anti-VEGF. No cases of endophthalmitis or RRD occurred.

Conclusions : Within one month of treatment, anti-VEGF therapy of PSR eyes resulted in high rates of seafan regression, significant clearing of vitreous hemorrhage, and stable or improved VA in a large majority.

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