Sickle cell retinopathy. A focused review

Research output: Contribution to journalReview article

Abstract

Purpose: To provide a focused review of sickle cell retinopathy in the light of recent advances in the pathogenesis, multimodal retinal imaging, management of the condition, and migration trends, which may lead to increased prevalence of the condition in the Western world. Methods: Non-systematic focused literature review. Results: Sickle retinopathy results from aggregation of abnormal hemoglobin in the red blood cells in the retinal microcirculation, leading to reduced deformability of the red blood cells, stagnant blood flow in the retinal precapillary arterioles, thrombosis, and ischemia. This may be precipitated by hypoxia, acidosis, and hyperosmolarity. Sickle retinopathy may result in sight threatening complications, such as paracentral middle maculopathy or sequelae of proliferative retinopathy, such as vitreous hemorrhage and retinal detachment. New imaging modalities, such as wide-field imaging and optical coherence tomography angiography, have revealed the microstructural features of sickle retinopathy, enabling earlier diagnosis. The vascular growth factor ANGPTL-4 has recently been identified as a potential mediator of progression to proliferative retinopathy and may represent a possible therapeutic target. Laser therapy should be considered for proliferative retinopathy in order to prevent visual loss; however, the evidence is not very strong. With recent development of wide-field imaging, targeted laser to ischemic retina may prove to be beneficial. Exact control of intraoperative intraocular pressure, including valved trocar vitrectomy systems, may improve the outcomes of vitreoretinal surgery for complications, such as vitreous hemorrhage and retinal detachment. Stem cell transplantation and gene therapy are potentially curative treatments, which may prevent retinopathy. Conclusions: There is lack of evidence regarding the optimal management of sickle retinopathy. Further study is needed to determine if recent progress in the understanding of the pathophysiology and diagnosis of sickle retinopathy may translate into improved management and outcome.

Details

Authors
  • Maram E.A. Abdalla Elsayed
  • Marco Mura
  • Hassan Al Dhibi
  • Silvana Schellini
  • Rizwan Malik
  • Igor Kozak
  • Patrik Schatz
Organisations
External organisations
  • Jeddah Eye Hospital
  • King Khaled Eye Specialist Hospital
  • Moorfields Eye Hospital Centre
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Ophthalmology

Keywords

  • Hemoglobin C, Hemoglobin S, Ischemia, Neovascularization, Panretinal photocoagulation, Sickle cell retinopathy
Original languageEnglish
Pages (from-to)1353-1364
JournalGraefe's Archive for Clinical and Experimental Ophthalmology
Volume257
Issue number7
Early online date2019
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes