目的:报道增生性镰状细胞视网膜病变(PSCR)的治疗方法和治疗效果。
方法:回顾性介入。
方法:回顾2017年至2022年间治疗的PSCR眼。患者人口统计学,介绍时的眼底发现,基因型,PSCR阶段,使用的治疗,和视觉结果进行了评估。
结果:研究了88例连续患者的108只眼。男:女48:40。平均年龄:38.91(SD:12.52)岁。基因型:镰状细胞血红蛋白C(SC)83眼(76.9%),镰状细胞血红蛋白S(SS)19眼(17.6%),镰状细胞特征(AS)6眼(5.5%)。PSCR分期:3:15眼(11.0%),4:74眼(67.0%),5:19眼(22.0%)。治疗方法:玻璃体内注射(IVI)抗血管内皮生长因子(VEGF)(27只眼,25%),仅散射视网膜激光光凝(SRLP)(7只眼,6.5%),玻璃体切除术+SRLP(29眼,26.9%),IVI+SRLP(25眼,23.1%),和玻璃体切除术+IVI+SRLP(20眼,18.5%)。所使用的治疗与PSCR阶段相关(p=0.000)。仅IVI主要用于治疗4期(81.4%),SRLP仅用于第3阶段(42.9%)和第5阶段(57.1%)。IVI+SRLP治疗的眼睛具有最佳的治疗前后视力。玻璃体切除术+SRLP治疗的眼睛视力改善最大。SRLP的视力改善最小。眼底发现与视力结果相关(p=0.003);但PSCR阶段,基因型与治疗方法无相关性(P>0.05)。
结论:几种方案可有效治疗PSCR。90.7%的治疗眼睛的视觉结果改善或保持相同。随机对照试验将确定PSCR每种不同表现的最佳治疗方法。治疗指南和具有预后价值的疾病分类系统是未满足的需求。
OBJECTIVE: To report treatment methods and visual outcome of treating proliferative sickle cell retinopathy (PSCR).
METHODS: Retrospective interventional.
METHODS: Review of PSCR eyes treated between 2017 to 2022. Patient demographics, fundus findings at presentation, genotype, PSCR stage, treatment used, and visual outcome were assessed.
RESULTS: 108 eyes of 88 consecutive patients were studied. Male: Female 48:40. Mean age: 38.91 (SD:12.52) years. Genotype: sickle cell haemoglobin C (SC) 83 eyes (76.9%), sickle cell haemoglobin S (SS) 19 eyes (17.6%), and sickle cell trait (AS) 6 eyes (5.5%). PSCR stages: 3: 15 eyes (11.0%), 4: 74 eyes (67.0%), and 5: 19 eyes (22.0%). Treatment methods: Intravitreal Injection (IVI) of anti-vascular endothelial growth factor (VEGF) only (27 eyes,25%), scatter retinal laser photocoagulation (SRLP) only (7 eyes, 6.5%), Vitrectomy + SRLP (29 eyes, 26.9%), IVI + SRLP (25 eyes, 23.1%), and Vitrectomy + IVI + SRLP (20 eyes, 18.5%). The treatment used correlated with PSCR stage (p = 0.000). IVI only was mostly used to treat stage 4 (81.4%), and SRLP only was used for stages 3 (42.9%) and 5 (57.1%). IVI + SRLP treated eyes had the best pre- and post-treatment vision. Vitrectomy + SRLP treated eyes had the most improved vision. SRLP only had least visual improvement. Fundus findings correlated with visual outcome (p = 0.003); but stage of PSCR, genotype and treatment used had no correlation (P > 0.05).
CONCLUSIONS: Several options effectively treat PSCR. Visual outcome improved or remained same in 90.7% of treated eyes. Randomized controlled trials will determine the optimum treatment for each distinct presentation of PSCR. Treatment guidelines and a disease classification system of prognostic value are unmet needs.