Analysis of Best Management of Proliferative Sickle Cell Retinopathy in An African PopulationA Retrospective Analytical Study

Abstract

Introduction: Visual impairment in Proliferative Sickle Cell Retinopathy (PSCR) starts with neovascularisation. Treatment armamentaria including diathermy, retinopexy, Autoinfarction (AI), surgical procedures and Intravitreal Anti-Vascular Endothelial Growth Factors Injections Monotherapy (AEGFM) have been applied. Some outcomes led to blindness but data on how effective AEGFM is in treating PSCR is lacking in several publications. Aim: To assess outcome and complication profile of large series of patients who underwent AEGFM after being diagnosed with PSCR. Materials and Methods: This was a retrospective analytical study conducted from October 2020 on records of patients who underwent AEGFM and other treatment on account of PSCR at Department of Ophthalmology, 37 Military Hospital, Accra, Ghana. The records were reviewed retrospectively for visual outcomes and complications. Patients’ demographic data, indications of treatment, best corrected preoperative and postoperative visual acuities, complications of surgery and length of follow-up were collected and analysed using chi-square and paired t-tests. Results: A total of 80 eyes of 40 patients (36 males and 4 females) were identified. Mean age during AEGFM (72 eyes) and vitreoretinal surgery (8 eyes) was 31.7±9.3 years (range 26-56 years) with mean follow-up period of 6±1 years (range 5-7 years). A total of 70 (87.5%), 2 (2.5%) and 8 eyes (10%) had improvement, maintenance and worsening of final visual acuities, respectively. A total of 8 (16%) eyes developed postoperative complications from retinal surgeries with Proliferative Vitreoretinopathy (PVR) being the most common. Forty (50%) eyes with old retinal Laser Photocoagulation (LP) scars reported with fresh elevated Sea Fans (SF) and Vitreous Haemorrhage (VH). LP is therefore a major source of SF formation and VH in PSCR. Conclusion: AEGFM is better treatment than other available modalities in management of undetached PSCR.