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Ali A. Neurologic Findings in Patients With Sickle Cell Disease: Carving a Path Between the Old and the New. Neurol Clin Pract 2024; 14:e200236. [PMID: 38144898 PMCID: PMC10741377 DOI: 10.1212/cpj.0000000000200236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/20/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Amza Ali
- Department of Medicine, Kingston Public Hospital and Faculty of Medical Sciences Department of Medicine, University of the West Indies, Kingston, Jamaica
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Nawaiseh M, Roto A, Nawaiseh Y, Salameh M, Haddadin R, Mango L, Nawaiseh H, Alsaraireh D, Nawaiseh Q, AlRyalat SA, Alwreikat A, Ramsey DJ, Abu-Yaghi N. Risk factors associated with sickle cell retinopathy: findings from the Cooperative Study of Sickle Cell Disease. Int J Retina Vitreous 2022; 8:68. [PMID: 36138487 PMCID: PMC9502612 DOI: 10.1186/s40942-022-00419-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 09/11/2022] [Indexed: 12/04/2022] Open
Abstract
Background Sickle cell retinopathy (SCR) is one of the most important ocular manifestations of sickle cell disease (SCD). This study aims to assess the prevalence of SCR in SCD, identify risk factors for its development and progression to proliferative sickle cell retinopathy (PSCR), and evaluate the potential implications of these results on clinical practice. Methods This research is a secondary analysis of patients diagnosed with SCD from the epidemiological, multicenter Cooperative Study of Sickle Cell Disease (CSSCD). We included all patients who completed a full ophthalmic evaluation. We identified clinical and laboratory SCD characteristics associated with SCR using multivariate logistic regression models. Proliferative sickle cell retinopathy (PSCR) was diagnosed according to the Goldberg classification system. Results Of the 1904 study participants with SCD who met the inclusion criteria, 953 (50.1%) had retinopathy; of which 642 (67.3%) had bilateral disease. SCR was associated with older age (p < 0.001), history of smoking (p = 0.001), hematuria (p = 0.050), and a lower hemoglobin F (HbF) level (p < 0.001). PSCR risk increased with smoking (p = 0.005), older age (p < 0.001) higher hemoglobin level (p < 0.001) and higher white blood cell count (p = 0.011). Previous blood transfusion (p = 0.050), higher reticulocyte count (p = 0.019) and higher HbF level (p < 0.001) were protective factors against the development of PSCR. Ocular symptoms were associated with progression to PSCR in patients with SCR (p = 0.021). Conclusion In this cohort of individuals with SCD, half of the participants had signs of SCR. Smoking and blood hemoglobin level were the two modifiable risk factors associated with increased retinopathy progression. Screening to identify the different stages of retinopathy, actively promoting smoking cessation, and optimizing the hematological profile of patients with SCD should guide treatment protocols designed to prevent the vision-threatening complications of the disease. Supplementary Information The online version contains supplementary material available at 10.1186/s40942-022-00419-8.
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Affiliation(s)
| | - Allaa Roto
- Al Bahar Eye center, Ibn Sina Hospital, Ministry of Health, Kuwait city, Kuwait
| | - Yara Nawaiseh
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Rund Haddadin
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Lana Mango
- School of Medicine, The University of Jordan, Amman, Jordan
| | | | | | - Qais Nawaiseh
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Saif Aldeen AlRyalat
- Department of Special Surgery, Ophthalmology Division, School of Medicine, The University of Jordan, P.O. Box: 7599, Amman, 11118, Jordan
| | - Amer Alwreikat
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA.,Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - David J Ramsey
- Division of Ophthalmology, Department of Surgery, Lahey Hospital & Medical Center, Burlington, MA, USA.,Department of Ophthalmology, Tufts University School of Medicine, Boston, MA, USA
| | - Nakhleh Abu-Yaghi
- Department of Special Surgery, Ophthalmology Division, School of Medicine, The University of Jordan, P.O. Box: 7599, Amman, 11118, Jordan.
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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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