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Ahmed I, Wakabayashi T, Gonzales AF, Ong SS, Light JG, Handa JT, Yonekawa Y, Scott AW. SURGICAL OUTCOMES OF RETINAL DETACHMENT ASSOCIATED WITH PROLIFERATIVE SICKLE CELL RETINOPATHY. Retina 2024; 44:1565-1571. [PMID: 39167578 DOI: 10.1097/iae.0000000000004145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
PURPOSE To evaluate the long-term anatomic and visual outcomes in eyes with sickle cell retinopathy-related retinal detachments (RDs). METHODS Patients who underwent surgery for sickle cell retinopathy-related RDs at the Wilmer Eye Institute or Wills Eye Hospital between 2008 and 2020 and followed for at least 6 months postoperatively were retrospectively reviewed. The primary outcome was the rate of single-surgery anatomic success and final reattachment. RESULTS This study included 30 eyes from 28 patients (16 women and 12 men) with tractional RD (n = 13), rhegmatogenous RD (n = 1), and combined tractional RD/rhegmatogenous RD (n = 16). Mean age was 42.1 ± 15.1 years. The mean follow-up duration was 47.8 ± 34.1 months. Twenty-five (83.3%) eyes underwent pars plana vitrectomy and five (16.7%) eyes underwent pars plana vitrectomy with scleral buckling. Single-surgery anatomic success was achieved in 21 (70.0%) eyes at 6 months. Final reattachment was achieved in 28 (93.3%) eyes (22 eyes [73.3%] without tamponade). Recurrence of RDs was significantly associated with male gender (P = 0.041), absence of previous laser (P = 0.032), iatrogenic breaks (P = 0.035), retinectomy (P = 0.034), and silicone oil tamponade (P = 0.024). Overall, the logarithm of the minimum angle of resolution visual acuity improved from 1.53 ± 0.57 (Snellen equivalent, 20/678) to 1.15 ± 1.01 (20/283) at the final visit (P = 0.03); however, eyes with recurrent RD did not achieve significant visual improvement. CONCLUSION Pars plana vitrectomy to repair sickle cell retinopathy-related RDs was effective in achieving anatomic success and improving vision in most eyes. Single-surgery anatomic success is critical for optimizing visual outcomes.
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Affiliation(s)
| | - Taku Wakabayashi
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | - Sally S Ong
- Wilmer Eye Institute, Baltimore, Maryland
- Wake Forest School of Medicine, Med Center Boulevard, Winston-Salem, North Carolina
| | - Jacob G Light
- Wilmer Eye Institute, Baltimore, Maryland
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | | | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania; and
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3
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Soni P, Dhingra B, Karkhur S, Chaudhary NK, Pakhare AP. Early diagnosis of sickle cell retinopathy by using ocular coherence tomography in pediatric population (7-18 years) in central India. Pediatr Blood Cancer 2024; 71:e31021. [PMID: 38644611 DOI: 10.1002/pbc.31021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/10/2024] [Accepted: 03/29/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Sickle cell disease (SCD) is the commonest inherited blood disorder leading to complications occurring due to vaso-occlusion including sight-threatening retinopathy. Retinopathy can be managed if diagnosed early and vision loss can be prevented. Since, very less data are available from India, hence, this study was conducted in children (7-18 years) with SCD to diagnose retinopathy by using ocular coherence tomography (OCT) in subclinical stages. METHODS This cross sectional single-center study was performed in 7-18 years age group children with SCD without any visual symptoms. Enrolled participants underwent complete ophthalmological examination including macula and optic disc thickness measurements using Cirrus HD-OCT and results were analyzed. RESULTS Among 55 participants, none had visual impairment. Significant fundoscopy finding (nonproliferative sickle cell retinopathy/NPSR) was found in three patients (5.4%), thinning of central macula in four patients (7.27%), inner macula thinning in eight patients (14.5%), outer macula thinning in one patient (1.81%), retinal nerve fiber layer thinning in five patients (9%), ganglion cell layer to inner plexiform layer thinning in eight patients (14.54%). Overall NPSR was found in 5.4% patients detected with fundoscopy, whereas retinal layer thinning was found in 14 patients (25.4%) using OCT. CONCLUSION Despite of the significant prevalence of SCR, it is still underdiagnosed complication, leading to thinning of the retina from early ages; thus, its early diagnosis by regular screening using newer diagnostic methods can prevent progression to sight-threatening complications and provide better quality of life for these patients.
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Affiliation(s)
- Pooja Soni
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Bhavna Dhingra
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Samendra Karkhur
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Narendra K Chaudhary
- Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Abhijit P Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
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5
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Dinah C, Balaskas K, Greystoke B, Awadzi R, Beke P, Ahern R, Talks J. Sickle Eye Project: a cross-sectional, non-interventional study of the prevalence of visual impairment due to sickle cell retinopathy and maculopathy in the UK. BMJ Open 2024; 14:e082471. [PMID: 38418238 PMCID: PMC10910489 DOI: 10.1136/bmjopen-2023-082471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/05/2024] [Indexed: 03/01/2024] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is one of the most common genetic disorders in the UK, with over 15 000 people affected. Proliferative sickle cell retinopathy (SCR) is a well-described complication of SCD and can result in significant sight loss, although the prevalence in the UK is not currently known. There are currently no national screening guidelines for SCR, with wide variations in the management of the condition across the UK. METHODS AND ANALYSIS The Sickle Eye Project is an epidemiological, cross-sectional, non-interventional study to determine the prevalence of visual impairment due to SCR and/or maculopathy in the UK. Haematologists in at least 16 geographically dispersed hospitals in the UK linked to participating eye clinics will offer study participation to consecutive patients meeting the inclusion criteria attending the sickle cell clinic. The following study procedures will be performed: (a) best corrected visual acuity with habitual correction and pinhole, (b) dilated slit lamp biomicroscopy and funduscopy, (c) optical coherence tomography (OCT), (d) OCT angiography where available, (e) ultrawide fundus photography, (f) National Eye Institute Visual Function Questionnaire-25 and (g) acceptability of retinal screening questionnaire. The primary outcome is the proportion of people with SCD with visual impairment defined as logarithm of the minimum angle of resolution ≥0.3 in at least one eye. Secondary outcomes include the prevalence of each stage of SCR and presence of maculopathy by age and genotype; correlation of stage of SCR and maculopathy to severity of SCD; the impact of SCR and presence of maculopathy on vision-related quality of life; and the acceptability to patients of routine retinal imaging for SCR and maculopathy. ETHICS AND DISSEMINATION Ethical approval was obtained from the South Central-Oxford A Research Ethics Committee (REC 23/SC/0363). Findings will be reported through academic journals in ophthalmology and haematology.
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Affiliation(s)
- Christiana Dinah
- Ophthalmology, London North West Healthcare NHS Trust, Harrow, UK
| | - Konstantinos Balaskas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Institute of Ophthalmology, UCL, London, UK
| | | | - Rossby Awadzi
- London North West University Healthcare NHS Trust, Harrow, UK
| | | | | | - James Talks
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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8
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Tozatto-Maio K, Girot R, Ly ID, Silva Pinto AC, Rocha V, Fernandes F, Diagne I, Benzerara Y, Dinardo CL, Soler JP, Kashima S, Araujo IL, Kenzey C, Fonseca GHH, Rodrigues ES, Volt F, Jarduli L, Ruggeri A, Mariaselvam C, Gualandro SFM, Rafii H, Cappelli B, Nogueira FM, Scigliuolo GM, Guerino-Cunha RL, Malmegrim KCR, Simões BP, Gluckman E, Tamouza R. Polymorphisms in Inflammatory Genes Modulate Clinical Complications in Patients With Sickle Cell Disease. Front Immunol 2020; 11:2041. [PMID: 33013863 PMCID: PMC7510050 DOI: 10.3389/fimmu.2020.02041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/27/2020] [Indexed: 01/27/2023] Open
Abstract
Sickle cell disease (SCD), the most common monogenic disease worldwide, is marked by a phenotypic variability that is, to date, only partially understood. Because inflammation plays a major role in SCD pathophysiology, we hypothesized that single nucleotide polymorphisms (SNP) in genes encoding functionally important inflammatory proteins might modulate the occurrence of SCD complications. We assessed the association between 20 SNPs in genes encoding Toll-like receptors (TLR), NK cell receptors (NKG), histocompatibility leukocyte antigens (HLA), major histocompatibility complex class I polypeptide-related sequence A (MICA) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), and the occurrence of six SCD clinical complications (stroke, acute chest syndrome (ACS), leg ulcers, cholelithiasis, osteonecrosis, or retinopathy). This study was performed in a cohort of 500 patients. We found that the TLR2 rs4696480 TA, TLR2 rs3804099 CC, and HLA-G, rs9380142 AA genotypes were more frequent in patients who had fewer complications. Also, in logistic regression, the HLA-G rs9380142 G allele increased the risk of cholelithiasis (AG vs. AA, OR 1.57, 95%CI 1.16-2.15; GG vs. AA, OR 2.47, 95%CI 1.34-4.64; P = 0.02). For SNPs located in the NKG2D loci, in logistic regression, the A allele in three SNPs was associated with a lower frequency of retinopathy, namely, rs2246809 (AA vs. GG: OR 0.22, 95%CI 0.09-0.50; AG vs. GG: OR 0.47, 95%CI 0.31-0.71; P = 0.004, for patients of same origin), rs2617160 (AT vs. TT: OR 0.67, 95%CI 0.48-0.92; AA vs. TT: OR 0.45, 95%CI 0.23-0.84; P = 0.04), and rs2617169 (AA vs. TT: OR 0.33, 95%CI 0.13-0.82; AT vs. TT: OR 0.58, 95%CI 0.36-0.91, P = 0.049, in patients of same SCD genotype). These results, by uncovering susceptibility to, or protection against SCD complications, might contribute to a better understanding of the inflammatory pathways involved in SCD manifestations and to pave the way for the discovery of biomarkers that predict disease severity, which would improve SCD management.
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Affiliation(s)
- Karina Tozatto-Maio
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco.,Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Indou Deme Ly
- National Children Hospital Center Albert Royer, Cheikh Anta Diop University, Dakar, Senegal
| | - Ana Cristina Silva Pinto
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Vanderson Rocha
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Fernandes
- Instituto de Matematica e Estatistica da Universidade de São Paulo, São Paulo, Brazil
| | - Ibrahima Diagne
- National Children Hospital Center Albert Royer, Cheikh Anta Diop University, Dakar, Senegal
| | - Yahia Benzerara
- Département de Bactériologie, Hôpital Saint-Antoine, Hôpitaux de l'Est parisien, Paris, France
| | - Carla L Dinardo
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Julia Pavan Soler
- Instituto de Matematica e Estatistica da Universidade de São Paulo, São Paulo, Brazil
| | - Simone Kashima
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Chantal Kenzey
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Guilherme H H Fonseca
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Evandra S Rodrigues
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Fernanda Volt
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Luciana Jarduli
- Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil.,School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Annalisa Ruggeri
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Haematology and Bone Marrow Transplant Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Cellular Therapy and Immunobiology Working Party, The European Society for Blood and Marrow Transplantation, Paris, France
| | | | - Sandra F M Gualandro
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Hanadi Rafii
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Barbara Cappelli
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Felipe Melo Nogueira
- Disciplina de Hematologia e Hemoterapia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Graziana Maria Scigliuolo
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
| | - Renato Luiz Guerino-Cunha
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil.,Center for Cell-based Therapy, Regional Blood Center of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Belinda P Simões
- Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Eliane Gluckman
- Eurocord, Université de Paris, IRSL, Hopital Saint Louis, Paris, France.,Monacord, International Observatory on Sickle Cell Disease, Centre Scientifique de Monaco, Monaco, Monaco
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Abdalla Elsayed MEA, Mura M, Al Dhibi H, Schellini S, Malik R, Kozak I, Schatz P. Sickle cell retinopathy. A focused review. Graefes Arch Clin Exp Ophthalmol 2019; 257:1353-1364. [PMID: 30895451 DOI: 10.1007/s00417-019-04294-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/23/2019] [Accepted: 03/10/2019] [Indexed: 10/27/2022] Open
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.
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Affiliation(s)
| | - Marco Mura
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Al-Oruba Street, 7191, Riyadh, 11462, Kingdom of Saudi Arabia
| | - Hassan Al Dhibi
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Al-Oruba Street, 7191, Riyadh, 11462, Kingdom of Saudi Arabia
| | - Silvana Schellini
- Oculoplasty Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Rizwan Malik
- Glaucoma Division, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Igor Kozak
- Moorfields Eye Hospital Centre, Abu Dhabi, United Arab Emirates
| | - Patrik Schatz
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Al-Oruba Street, 7191, Riyadh, 11462, Kingdom of Saudi Arabia. .,Department of Ophthalmology, Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
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