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Enjalbert A, Giocanti-Auregan A, Fajnkuchen F, Torres-Villaros H. LONGITUDINAL ANALYSIS OF MICROVASCULAR CHANGES IN SICKLE CELL DISEASE USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY. Retina 2024; 44:572-580. [PMID: 38029421 DOI: 10.1097/iae.0000000000004013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE To analyze the changes in macular vascular densities (VDs) and foveal avascular zone (FAZ) over a 6-year period using swept-source optical coherence tomography angiography in patients with sickle cell disease compared with unaffected control subjects. METHODS Thirty eyes of patients with sickle cell disease and 12 eyes of unaffected control subjects matched for age and ethnicity were examined at a 6-year interval using the same imaging protocol, including ultra-wide-field angiography, swept-source OCT, and 3 × 3-mm optical coherence tomography angiography. The macular VD and FAZ were measured on ImageJ software according to previously reported algorithms. RESULTS In sickle cell eyes, the mean FAZ significantly increased ( P < 0.01), and the VD decreased in the foveal (within a circle of 1.5 mm in diameter around the foveal center) and temporal areas in both the superficial and the deep capillary plexuses ( P < 0.01). The VD did not change over time in the parafoveal area (annulus between two circles of 1.5 and 3 mm in diameter) and in the superior, inferior, and nasal sectors. No worsening of peripheral retinopathy was observed in the cohort during the follow-up, except for one eye that developed sea-fan. In the control eyes, no microvascular change was observed over time in FAZ size and VD. CONCLUSION These longitudinal optical coherence tomography angiography findings in patients with sickle cell disease showed an enlargement of the FAZ and a decrease in VD in the temporal and perifoveal regions despite the absence of progression of peripheral retinopathy, suggesting a worsening of the macular nonperfusion over time in sickle cell disease.
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Affiliation(s)
- Aurélie Enjalbert
- Department of Ophthalmology, Avicenne Hospital, APHP and University Paris 13, Bobigny, France; and
| | - Audrey Giocanti-Auregan
- Department of Ophthalmology, Avicenne Hospital, APHP and University Paris 13, Bobigny, France; and
| | - Franck Fajnkuchen
- Department of Ophthalmology, Avicenne Hospital, APHP and University Paris 13, Bobigny, France; and
- Ophthalmology Center for Imaging and Laser, Paris, France
| | - Héloïse Torres-Villaros
- Department of Ophthalmology, Avicenne Hospital, APHP and University Paris 13, Bobigny, France; and
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Hoyek S, Lemire C, Halawa O, Altamirano-Lamarque F, Gonzalez E, Patel NA. Longitudinal Assessment of Macular Thickness and Microvascular Changes in Children with Sickle Cell Disease. Ophthalmol Retina 2024; 8:184-194. [PMID: 37696394 DOI: 10.1016/j.oret.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE To longitudinally assess macular thickness and microvascular changes in children with sickle cell disease (SCD). DESIGN A retrospective consecutive series. SUBJECTS Children with SCD aged ≤ 18 years who had an ophthalmic examination at Boston Children's Hospital between January 1998 and August 2022. METHODS Qualitative and quantitative analyses of both OCT and OCT angiography (OCTA) images were performed. MAIN OUTCOME MEASURES Total retinal thickness measured on macular OCT, superficial capillary plexus and deep capillary plexus (DCP) vessel density (VD), and foveal avascular zone (FAZ) area measured on 6- × 6-mm OCTA scans. RESULTS International Classification of Diseases, 10th Revision, code search identified 303 pediatric SCD patients who underwent ophthalmic examination during the study period. OCT and OCTA images were acquired on 104 (17.2%) and 60 (9.9%) eyes at presentation and on 159 (26.2%) and 100 (16.5%) eyes at final visit, respectively. Overall, temporal retinal thinning was noted qualitatively in 35.6% of SCD patients at presentation and 39.6% at final visit. Of those patients with macular thinning, 94.6% and 90.5% had peripheral sickle cell retinopathy (SCR) at presentation and final visit. On quantitative OCT analysis, HbSS eyes had a lower retinal thickness in the fovea and temporal parafovea compared with HbSC (P < 0.05). Eyes with peripheral SCR had a larger FAZ at presentation compared with eyes without peripheral SCR (P = 0.004), a lower DCP VD at final visit in the inferior temporal macula (P = 0.03), and a higher DCP VD at final visit in the superior nasal macula (P = 0.01). Eighty eyes of 40 patients had OCT, and 34 eyes of 20 patients had both OCT and OCTA images acquired at both initial and final visits. At final visit, retinal thickness decreased at the fovea, inferior perifovea, and temporal perifovea compared with presentation (P < 0.05). In parallel, VD DCP in the superonasal quadrant increased at final visit (P = 0.03). CONCLUSIONS Macular retinal thinning was progressive and observed in eyes with and without peripheral SCR. Over time, there was a compensatory increase in DCP VD in the nasal macula on OCTA. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Sandra Hoyek
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Colin Lemire
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Omar Halawa
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Efren Gonzalez
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nimesh A Patel
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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3
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Brandsen RP, Diederen RMH, Bakhlakh S, Nur E, Schlingemann RO, Biemond BJ. Natural history and rate of progression of retinopathy in adult patients with sickle cell disease: an 11-year follow-up study. Blood Adv 2023; 7:3080-3086. [PMID: 36897257 PMCID: PMC10331402 DOI: 10.1182/bloodadvances.2022009147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Sickle cell retinopathy (SCR) is a complication of sickle cell disease (SCD). Proliferative SCR (PSCR) can lead to severe visual impairment due to vitreous hemorrhage or retinal detachment. Knowledge of risk factors for progression and complications of SCR is limited. The aim of this study is to describe the natural history of SCR and to identify risk factors for progressive SCR and development of PSCR. We retrospectively analyzed disease progression in 129 patients with SCD with a median follow-up period of 11 years (interquartile range, 8.5-12). Patients were divided in 2 groups. The genotypes hemoglobin SS (HbSS), HbSβ0-thalassemia, and HbSβ+-thalassemia were grouped together (n = 83; 64.3%), whereas patients with HbSC (n = 46; 35.7%) were grouped separately. Progression of SCR was observed in 28.7% (37 of 129) of patients. Older age (adjusted odds ratio [aOR], 1.073; 95% confidence interval [CI], 1.024-1.125; P = .003), HbSC genotype (aOR, 25.472; 95% CI, 3.788-171.285; P ≤ 0.001), and lower HbF (aOR, 0.786; 95% CI, 0.623-0.993; P = .043) were associated with PSCR at end of follow-up. Lack of any SCR at end of follow-up was associated with female sex (aOR, 2.555; 95% CI, 1.101-5.931; P = .029), HbSS/HbSβ0/HbSβ+ genotype (aOR, 3.733; 95% CI, 1.131-12.321; P = .031), and higher HbF levels (aOR, 1.119; 95% CI, 1.007-1.243; P = .037). Differentiated strategies for screening and follow-up of SCR could be considered for patients at low or high risk.
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Affiliation(s)
- Rajani P. Brandsen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Roselie M. H. Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Siham Bakhlakh
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Reinier O. Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Bart J. Biemond
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Martin GC, Brousse V, Connes P, Grevent D, Kossorotoff M, Da Costa L, Bourdeau H, Charlot K, Boutonnat-Faucher B, Allali S, De Montalembert M, Bremond-Gignac D, Vidal PP, Robert MP. Retinal atrophy and markers of systemic and cerebrovascular severity in homozygous sickle cell disease. Eur J Ophthalmol 2022; 32:3258-3266. [DOI: 10.1177/11206721221090794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction While paramacular retinal atrophy (PRA) is known to be found in 48% of eyes of adults and 42% of eyes of children with homozygous SCD (SS-SCD), the aim of this study is to assess the association between PRA and red blood cell (RBC) deformability, hematological markers and brain imaging abnormalities in SS-SCD. Methods This study is a subset of DREAM2, a prospective observational study performed between August 2015 and August 2016. Children (5–17 years) with SS-SCD and no history of large vessel vasculopathy, were included. Ophthalmological characteristics including visual acuity, fundus examination, OCT of central and temporal retina (with several retinal thickness measurements) were explored in relation with RBC deformability (ektacytometry), hematological and biochemical (hemolysis parameters), and neurological (cerebral oxygenation estimated by Near Infrared Spectroscopy, brain magnetic resonance imaging) investigations. Results 17 children (5 boys; mean age: 13 years) with complete ophthalmological investigations were included in the analysis; 8 exhibited PRA. RBC deformability was found to be significantly lower in children with PRA for measurements made at 1.69 Pa (0.16 a.u ± 0.02 vs 0.21 a.u ± 0.03, p = 0.02) and above, as well as cerebral oxygenation (59.25% ± 9.9 vs 71.53% ± 4.9, p = 0.02). A significant positive correlation was found between temporal retinal thickness and hemoglobin level (ρ = 0.65, p = 0.007), hematocrit (ρ = 0.53, p = 0.04) and RBC deformability at 3 Pa (ρ = 0.75, p = 0.005) and above. Conclusions These results suggest that PRA could be an early marker of systemic severity and cerebral oxygenation in SCD. Whether it could help predicting cerebral vasculopathy requires further investigations.
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Affiliation(s)
- Gilles C. Martin
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
- Ophthalmology Department, Rothschild Foundation Hospital, Paris, France
| | - Valentine Brousse
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- Institut National de la transfusion sanguine, UMR_S1134, Inserm, Paris, France
- LABEX GR-Ex, France
| | - Philippe Connes
- Faculté de Médecine Rockefeller, Laboratoire inter-universitaire de Biologie de la Motricité (LIBM EA7424), Equipe « Biologie Vasculaire et du Globule Rouge », Université Claude Bernard Lyon 1, Lyon, France
| | - David Grevent
- Radiology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Lydie Da Costa
- Institut National de la transfusion sanguine, UMR_S1134, Inserm, Paris, France
- LABEX GR-Ex, France
- AP-HP, Hôpital Robert Debré, service d’Hématologie Biologique, Paris, France
| | - Hélène Bourdeau
- Pediatric Neurology Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
| | - Keyne Charlot
- Unité de Physiologie des Exercices et Activités en Conditions Extrêmes, Département Environnements Opérationnels Institut de Recherche Biomédicale des Armées, France
| | | | - Slimane Allali
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- LABEX GR-Ex, France
| | - Mariane De Montalembert
- General Pediatrics Department, Necker-Enfants Malades University Hospital, APHP, Paris, France
- LABEX GR-Ex, France
| | - Dominique Bremond-Gignac
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- INSERM UMRS 1138, Team 17, Centre de Recherche des Cordeliers, Sorbonne Paris University, France
| | - Pierre-Paul Vidal
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
| | - Matthieu P. Robert
- Ophthalmology Department and Rare Ophthalmological Diseases Reference Centre (OPHTARA), Necker-Enfants Malades University Hospital, APHP, Paris, France
- Borelli Centre, CNRS-SSA-ENS Paris Saclay-Paris University, Paris, France
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Sickle Cell Trait Presenting as Unilateral Proliferative Retinopathy and Macular Thinning in a Pregnant Woman. Case Rep Ophthalmol Med 2021; 2021:5988889. [PMID: 34931150 PMCID: PMC8684531 DOI: 10.1155/2021/5988889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background To report a case of a pregnant woman with sickle cell trait (SCT) who presented with unilateral proliferative sickle cell retinopathy. Case Presentation. A 26-year-old otherwise healthy pregnant woman presented with the complaint of visual loss in her left eye. The funduscopic examination showed vitreous hemorrhage, sea fan neovascularization, and pale optic disc. Optical coherence tomography revealed macular inner retinal layer thinning and foveal splaying (saucerization of the foveal pit). The investigations, including hemoglobin electrophoresis, verified the diagnosis of sickle cell trait. Blood pressure, fasting blood glucose tests, and tuberculin skin tests were normal. We treated the patient by peripheral retinal photocoagulation over the area of nonperfusion. Conclusion Even though the sickle cell trait is generally considered as a milder form of sickle cell disease without severe retinal manifestations, pregnancy should be considered as a trigger that can induce proliferative changes and foveal splaying in this group of patients.
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6
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Cai S, Han IC, Scott AW. Artificial intelligence for improving sickle cell retinopathy diagnosis and management. Eye (Lond) 2021; 35:2675-2684. [PMID: 33958737 PMCID: PMC8452674 DOI: 10.1038/s41433-021-01556-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/17/2021] [Accepted: 04/13/2021] [Indexed: 02/04/2023] Open
Abstract
Sickle cell retinopathy is often initially asymptomatic even in proliferative stages, but can progress to cause vision loss due to vitreous haemorrhages or tractional retinal detachments. Challenges with access and adherence to screening dilated fundus examinations, particularly in medically underserved areas where the burden of sickle cell disease is highest, highlight the need for novel approaches to screening for patients with vision-threatening sickle cell retinopathy. This article reviews the existing literature on and suggests future research directions for coupling artificial intelligence with multimodal retinal imaging to expand access to automated, accurate, imaging-based screening for sickle cell retinopathy. Given the variability in retinal specialist practice patterns with regards to monitoring and treatment of sickle cell retinopathy, we also discuss recent progress toward development of machine learning models that can quantitatively track disease progression over time. These artificial intelligence-based applications have great potential for informing evidence-based and resource-efficient clinical diagnosis and management of sickle cell retinopathy.
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Affiliation(s)
- Sophie Cai
- Retina Division, Duke Eye Center, Durham, NC, USA
| | - Ian C Han
- Institute for Vision Research, Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine and Hospital, Baltimore, MD, USA.
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7
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Jin J, Vinay K, Miller RE. Monitoring retinal pathology and cerebral injury in sickle cell disease using spectral-domain optical coherence tomography in pediatric patients. Pediatr Blood Cancer 2021; 68:e29028. [PMID: 33788385 PMCID: PMC8638774 DOI: 10.1002/pbc.29028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to confirm the correlation between sickle cell disease (SCD) genotype and retinal damage identified by spectral-domain optical coherence tomography (SD-OCT), and examine a potential link between hypoxic ischemic injury in the retina and brain. METHODS In this prospective, observational case series, 117 patients (56 males) aged 5-20 years with SCD (36 SC, 68 SS, eight Sβ+ thalassemia, five Sβ0 thalassemia) underwent ophthalmologic examination including funduscopy and SD-OCT imaging. Comparison of SCD genotypes and association between ocular findings and cerebrovascular disease (CVD) in subjects with SS/Sβ0 genotype were investigated. RESULTS Visual acuity ranged from 20/20 to 20/40. On funduscopic exam, 16 of 117 (13.7%) had retinopathy; 69 of 117 (59.0%) showed inner retina thinning on SD-OCT. Patients with SS/Sβ0 showed a higher frequency of sickle cell retinopathy (SCR) change (68.5% vs. 47.2%), bilateral SCR (49.9% vs. 25.0%), and foveal involvement (15.1% vs. 0) than the SC genotype. While funduscopic findings in our cohort with SS/Sβ0 genotype showed no correlation with CVD, 20 of 21 patients with CVD had abnormal SD-OCT. Elevated reticulocyte percentage and aspartate aminotransferase are associated with SD-OCT changes and CVD. CONCLUSIONS SD-OCT was better than funduscopy in detecting retinal changes, higher frequency, and more extensive retinal changes in the more severe SCD genotypes SS and Sβ0 as compared with SC. The correlation between abnormal SD-OCT and CVD strongly suggests that retinal exam using SD-OCT may aid in detection and monitoring SCD-related CVD. Retinopathy may be another component of the hemolytic subphenotype of SCD.
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Affiliation(s)
- Jing Jin
- Division of Pediatric Ophthalmology, Nemours/Alfred l. duPont Hospital for Children, Wilmington, DE
| | - Kandula Vinay
- Department of Radiology, Nemours/Alfred l. duPont Hospital for Children, Wilmington, DE
| | - Robin E. Miller
- Center for Cancer and Blood Disorders, Nemours/Alfred l. duPont Hospital for Children, Wilmington, DE
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8
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Seafans to Sunbursts: From History to the Horizon in Sickle Cell Retinopathy: Reflections on 50 Years Since Goldberg Staging. Retina 2021; 41:1361-1363. [PMID: 33990117 DOI: 10.1097/iae.0000000000003206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lim JI, Niec M, Sun J, Cao D. Longitudinal Assessment of Retinal Thinning in Adults With and Without Sickle Cell Retinopathy Using Spectral-Domain Optical Coherence Tomography. JAMA Ophthalmol 2021; 139:330-337. [PMID: 33538815 DOI: 10.1001/jamaophthalmol.2020.6525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Importance Determination of retinal thinning rates may help to identify patients who are at risk of progression of sickle cell retinopathy. Objective To assess the rates of macular thinning in adults with and without sickle cell retinopathy using spectral-domain optical coherence tomography (OCT) and to identify ocular and systemic risk factors associated with retinal thinning. Design, Setting, and Participants This longitudinal prospective case-control study enrolled adult participants from a university-based retina subspecialty clinic between February 11, 2009, and July 3, 2019. The study was designed in autumn 2008 and conducted from February 2, 2009, to July 3, 2020. Participants with sickle cell retinopathy (sickle cell group) were matched by age and race with participants without sickle cell retinopathy (control group). Participants received annual spectral-domain OCT and clinical examinations. Those with at least 1 year of follow-up by July 3, 2020, were included in the analysis. Data were analyzed from February 2, 2009, to July 3, 2020. Main Outcomes and Measures The primary outcome was comparison of spectral-domain OCT measurements from early-treatment diabetic retinopathy study subfield rates of retinal thinning between eyes with and without sickle cell retinopathy and between different sickle cell hemoglobin subtypes. The secondary outcome was identification of ocular and systemic risk factors associated with rates of retinal thinning. Results Among 370 adults (711 eyes) enrolled in the study, 310 participants (606 eyes) had sickle cell retinopathy, and 60 participants (105 eyes) did not. Of those, 175 of 310 participants (56.5%; 344 of 606 eyes [56.8%]; mean [SD] age, 37.8 [12.8] years; 126 women [72.0%]) in the sickle cell group and 31 of 60 participants (51.7%; 46 of 105 eyes [43.8%]; mean [SD] age, 59 [15.4] years; 22 women [71.0%]) in the control group had at least 1 year of clinical and spectral-domain OCT follow-up data from baseline. The mean (SD) follow-up was 53.7 (32.6) months for the sickle cell group and 54.6 (34.9) months for the control group. Rates of macular thinning in the sickle cell group were significantly higher than those in the control group for the inner nasal (difference, -1.18 μm per year; 95% CI, -1.71 to -0.65 μm per year), inner superior (difference, -1.03 μm per year; 95% CI, -1.78 to -0.29 μm per year), inner temporal (difference, -0.61 μm per year; 95% CI, -1.16 to -0.07 μm per year), and outer nasal (difference, -0.41 μm per year; 95% CI, -0.80 to -0.03 μm per year) quadrants. Patients with sickle cell hemoglobin SC and sickle cell hemoglobin β-thalassemia subtypes had higher rates of retinal thinning than those with the sickle cell hemoglobin SS subtype. Risk factors associated with greater rates of retinal thinning included participant age, stage of retinopathy, previous stroke, and presence of hypertension, acute chest syndrome, or diabetes. Hydroxyurea therapy was associated with decreased rates of retinal thinning and may be a protective factor. Conclusions and Relevance In this study, rates of retinal thinning were higher among participants with sickle cell retinopathy compared with those without sickle cell retinopathy, and thinning rates increased with participant age and stage of retinopathy. These findings suggest that identifying anatomic worsening of sickle cell maculopathy through spectral-domain OCT may be a useful parameter to evaluate the progression of sickle cell retinopathy.
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Affiliation(s)
- Jennifer I Lim
- Department of Ophthalmology, University of Illinois at Chicago, Chicago.,Associate Deputy Editor, JAMA Ophthalmology
| | - Marcia Niec
- Department of Ophthalmology, University of Illinois at Chicago, Chicago
| | - Jie Sun
- Department of Ophthalmology, University of Illinois at Chicago, Chicago
| | - Dingcai Cao
- Department of Ophthalmology, University of Illinois at Chicago, Chicago
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10
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Abu-Yaghi NE, AlNawaiseh AM, Khourshid IM, AlRawashdeh TJ, Rawashdeh MMA, Zghoul AM, Shafagoj AN, Alomairi YA, Muhsen SM, AlRyalat SS. Central macular thickness in patients with sickle cell disease and no signs of retinopathy: a cross-sectional study of Jordanian patients. J Int Med Res 2021; 49:300060520977387. [PMID: 33827305 PMCID: PMC8040581 DOI: 10.1177/0300060520977387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To measure central macular thickness in Jordanian patients with sickle cell disease who did not have retinopathy and compare the findings with age- and sex-matched controls using spectral domain optical coherence tomography (SDOCT). METHODS In this cross-sectional study, participants underwent visual acuity testing, slit-lamp bio-microscopy, dilated ophthalmoscopy, and SDOCT imaging to measure central macular thickness. Macular quadrant measurements and thickness difference indexes (TDIs) were compared between groups. RESULTS Twenty eyes with sickle cell disease and 20 control eyes were enrolled. The median visual acuity in both groups was 20/20. The mean macular thickness was significantly lower in eyes with sickle cell disease than in matched controls (mean difference, 22.15 ± 6.44 µm). Peripheral quadrants were all significantly thinner in eyes with sickle cell disease, especially in superior and temporal quadrants. TDIs were lower in eyes with sickle cell disease than in control eyes. CONCLUSIONS Eyes with sickle cell disease that had no clinical evidence of retinopathy exhibited significantly lower central macular thickness in all quadrants, compared with eyes in age- and sex-matched controls. SDOCT is a non-invasive imaging modality that can detect preclinical changes in eyes with sickle cell disease and can be used to screen and monitor the disease process.
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Affiliation(s)
- Nakhleh E Abu-Yaghi
- Special Surgery Department/Ophthalmology Division, School of Medicine, University of Jordan, Amman, Jordan
| | | | | | | | | | - Ayat M Zghoul
- School of Medicine, University of Jordan, Amman, Jordan
| | | | | | - Sana' M Muhsen
- Special Surgery Department/Ophthalmology Division, School of Medicine, University of Jordan, Amman, Jordan
| | - SaifAldeen S AlRyalat
- Special Surgery Department/Ophthalmology Division, School of Medicine, University of Jordan, Amman, Jordan
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11
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Variable Practice Patterns for Management of Sickle Cell Retinopathy. Ophthalmol Retina 2020; 5:715-717. [PMID: 33301951 DOI: 10.1016/j.oret.2020.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/18/2020] [Indexed: 11/24/2022]
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12
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Sahak H, Saqalain M, Lott PW, McKibbin M. Sickle Cell Maculopathy: Prevalence, Associations and Impact on Visual Acuity. Ophthalmologica 2020; 244:159-164. [PMID: 33120391 DOI: 10.1159/000512636] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/14/2020] [Indexed: 11/19/2022]
Abstract
AIMS To investigate the prevalence of sickle cell maculopathy (SCM), and associations with age, sex, genotype, proliferative sickle cell retinopathy (PSR) stage, and the impact on visual acuity. METHODS Age, sex, and visual acuity were recorded and spectral domain OCT and ultra-wide-field images of the macula and retina were reviewed in a consecutive series of 74 adults with sickle cell disease. RESULTS The median age was 37 years (range 19-73 years) and 36 cases (48.6%) were male. SCM was present in at least 1 eye of 40 cases (54.1%) or in 67 of all eyes (42.3%). SCM prevalence was 54.8%, 62.5%, and 25% for the HbSS, HbSC, and HbS/BThal or other genotypes, respectively. SCM was observed in 41 (39.4%) of the eyes with PSR stages 0, 1, and 2, and in 21 (51.2%) of the eyes with PSR stages 3, 4, and 5, respectively. Mild visual impairment or worse was present in 3 eyes (4.8%) with SCM but this was secondary to other pathology. CONCLUSION SCM is a frequent finding in the eyes of adults with sickle cell disease. The prevalence is similar for the HbSS and HbSC genotypes and is not related to the PSR stage. High-contrast distance visual acuity is typically preserved.
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Affiliation(s)
- Haroen Sahak
- School of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Mohammed Saqalain
- School of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Pooi Wah Lott
- University Malaya Eye Research Centre, Department of Ophthalmology, University of Malaya, Kuala Lumpur, Malaysia
| | - Martin McKibbin
- School of Medicine and Health, University of Leeds, Leeds, United Kingdom, .,Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom,
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Ong SS, Linz MO, Li X, Liu TA, Han IC, Scott AW. Retinal Thickness and Microvascular Changes in Children With Sickle Cell Disease Evaluated by Optical Coherence Tomography (OCT) and OCT Angiography. Am J Ophthalmol 2020; 209:88-98. [PMID: 31473216 DOI: 10.1016/j.ajo.2019.08.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To compare the severity of macular vascular changes in children with sickle cell disease (SCD) vs age- and race-matched controls. DESIGN Cross-sectional study. METHODS Children (<18 years old) with HbSS and HbS variant (HbSC and HbS thalassemia) genotypes, and their age- and race-matched controls, were recruited between January 2017 and December 2018. All subjects underwent optical coherence tomography angiography (OCTA) scans centered on the fovea and temporal macula. Retinal thickness, superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density (VD), and foveal avascular zone (FAZ) size were measured and compared between HbSS and HbS variant vs controls. RESULTS Thirty-four HbSS, 34 HbS variant (Goldberg staging 0-3 for SCD eyes), and 24 control eyes (total 48 children, aged 5-17 years) were included. Total VD (3-mm ETDRS circle) was lower in HbS variant eyes than in controls for both the SCP (42.9% vs 47.7%, P = .02) and DCP (47.4% vs 52.6%, P = .01). In HbSS eyes, VD was lower in the DCP (47.7%, P = .008) but not in the SCP (45.5%, P = .5), compared to controls. A higher proportion of HbSS (n = 18, 55%) than HbS variant eyes (n = 9, 26%) had pathologic areas of retinal thinning associated with SCP and DCP flow loss (P = .03). However, retinal thickness measurements and FAZ size did not differ between either HbSS or HbS variant group vs controls. CONCLUSIONS Children with SCD have similar retinal thickness but less dense vasculature on OCTA compared to age and race-matched controls, suggesting that microvascular insult may precede structural thinning.
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[Role of OCT-angiography in the management of sickle cell retinopathy]. J Fr Ophtalmol 2019; 43:7-17. [PMID: 31831271 DOI: 10.1016/j.jfo.2019.06.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/05/2019] [Accepted: 06/26/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Sickle cell retinopathy is the main ophthalmologic complication of sickle cell syndrome. Optical coherence tomography (OCT) and optical coherence tomography-angiography (OCT-A) permit demonstration of central retinal involvement. The goal of this study is to determine whether central retinal involvement is predictive of peripheral retinal ischemia. MATERIALS AND METHODS We carried out a retrospective study of 31 patients with sickle cell disease who underwent a complete ophthalmologic examination. We focused on capillary density of the superficial and deep plexuses and the central avascular surface by OCT-A, and retinal layer thickness by OCT. All of the findings obtained by OCT-A and OCT were classified according to the Goldberg stages on fluorescein angiography. RESULTS A thinning of the mean and temporal deep plexus capillary layer as well as a loss of the temporal density of the superficial plexus capillaries are significantly higher in the case of proliferative sickle cell retinopathy (P=<0.05). A significant negative correlation is observed between the mean and temporal density of the superficial (R=-0.31; P=0.02 and R=-0.43; P=0.0009) and deep plexus capillaries (R=-0.39; P=0.003 et R=-0.43; P=0.0009) and the Goldberg stage in fluorescein angiography. CONCLUSION The study of the temporal capillary densities of the superficial and deep plexuses on OCT angiography may prove to be a useful tool for the ophthalmologist in order to diagnose patients at risk for proliferative sickle cell retinopathy.
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Thavikulwat AT, Cao D, Vajaranant TS, Lim JI. Longitudinal Study of Peripapillary Thinning in Sickle Cell Hemoglobinopathies. Am J Ophthalmol 2019; 202:30-36. [PMID: 30771331 DOI: 10.1016/j.ajo.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/31/2019] [Accepted: 02/06/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE To determine the rate of retinal nerve fiber layer (RNFL) thinning in patients with sickle cell hemoglobinopathies. DESIGN This was a prospective cohort study. METHODS Sixty-seven patients averaging 35.8 ± 11.5 years of age at enrollment with electrophoretically confirmed sickle cell hemoglobinopathies followed by the University of Illinois at Chicago retina clinic for ≥1 year were included. Exclusion criteria included a history of diabetes, uncontrolled hypertension, glaucoma, ocular opacities, other retinopathies, and previous retinal procedures. The optic nerve head RNFL thicknesses were measured with spectral-domain optical coherence tomography (Heidelberg Engineering, Inc) at enrollment and subsequent follow-ups. Linear mixed models were used to estimate rates of thinning. RESULTS A total of 122 eyes were followed for 3.8 ± 2.0 years (range 1-8 years). Mean global peripapillary RNFL thickness was 100.9 ± 13.0 μm at baseline. Global peripapillary RNFL thickness decreased at a rate of 0.98 μm per year (95% confidence interval [CI] 0.77-1.19 μm/year). A history of stroke was associated with a faster rate of global RNFL thinning (1.72 ± 0.20 vs 0.79 ± 0.12 μm/year, P < .001), whereas a history of hypertension was associated with a slower rate of thinning (0.33 ± 0.27 vs 1.14 ± 0.12 μm/year, P = .002). CONCLUSIONS Peripapillary RNFL thinning in patients with sickle cell hemoglobinopathies occurred faster in patients with a history of stroke and slower in patients with controlled hypertension. Future studies will compare these rates to those of healthy age- and race-matched individuals.
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Hussnain SA, Coady PA, Slade MD, Carbonella J, Pashankar F, Adelman RA, Stoessel KM. Hemoglobin level and macular thinning in sickle cell disease. Clin Ophthalmol 2019; 13:627-632. [PMID: 31114143 PMCID: PMC6489663 DOI: 10.2147/opth.s195168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/28/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: To study the relationship between complete blood count (CBC) indices over time, particularly serum hemoglobin (Hb) levels, and severity of macular thinning on spectral domain optical coherence tomography (SD-OCT) in patients with sickle cell disease (SCD). Methods: This is a single-center, retrospective analysis of 141 consecutive SCD patients over a 10-year period, of which 40 patients (79 eyes) had SD-OCT imaging of the macula and 29 (58 eyes, mean age 17.5 years) were eligible for the study. Investigators reviewed electronic medical records for documentation of retinopathy stage, disease genotype, CBC values, and SD-OCT imaging. SD-OCT parameters and CBC values were compared between different retinopathy stages and disease genotypes. Regression analyses were performed on SD-OCT parameters and CBC values. Results: Of the 58 eligible eyes (34HbSS, 18HbSC, 4HbSβ +thal, 2HbS βthal), 18 had PSR (proliferative sickle retinopathy), 14 had NPSR (nonproliferative sickle retinopathy), and 26 had NSR (no sickle retinopathy). Hb values were higher in SC group compared to SS group. Macular thickness in the temporal inner (Δ=26±33 um, p=0.01) and outer (Δ=21±30 um, p=0.02) subfields was higher in SC compared to SS group. Patients with SD-OCT thinning below the 5th percentile in the temporal outer subfields had lower recorded Hb nadirs (6.0±0.9) compared to those with thickness within the top 95th percentile (9.1±2.3). Regression analysis showed temporal macular thickness to be positively correlated with Hb values in the SS group. Conclusion: Macular thinning observed on SD-OCT in SCD patients with SS genotype may be related to the level of anemia in this population.
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Affiliation(s)
- S Amal Hussnain
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA.,Department of Ophthalmology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Vitreous Retina Macula Consultants of New York, New York, NY, USA.,Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Patrick A Coady
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA.,New England Retina Associates, Hamden, CT, USA
| | - Martin D Slade
- Department of Internal Medicine, Yale University School of Medicine and Yale School of Public Health, New Haven, CT, USA
| | - Judith Carbonella
- Department of Pediatric Hematology and Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Farzana Pashankar
- Department of Pediatric Hematology and Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Ron A Adelman
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
| | - Kathleen M Stoessel
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT, USA
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Leitão Guerra RL, Leitão Guerra CL, Bastos MG, de Oliveira AHP, Salles C. Sickle cell retinopathy: What we now understand using optical coherence tomography angiography. A systematic review. Blood Rev 2019; 35:32-42. [DOI: 10.1016/j.blre.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/01/2019] [Accepted: 03/01/2019] [Indexed: 12/20/2022]
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Cai CX, Han IC, Tian J, Linz MO, Scott AW. Progressive Retinal Thinning in Sickle Cell Retinopathy. ACTA ACUST UNITED AC 2018; 2:1241-1248.e2. [DOI: 10.1016/j.oret.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/08/2018] [Accepted: 07/10/2018] [Indexed: 02/05/2023]
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