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de Ligt LA, Gaartman AE, Biemond BJ, Fijnvandraat K, van Bruggen R, Nur E. Neutrophils in sickle cell disease: Exploring their potential role as a therapeutic target. Am J Hematol 2024; 99:1119-1128. [PMID: 38293835 DOI: 10.1002/ajh.27224] [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: 10/11/2023] [Revised: 12/15/2023] [Accepted: 01/01/2024] [Indexed: 02/01/2024]
Abstract
Factors influencing the activation of neutrophils in SCD and the potential neutrophil-mediated ameliorating effects of therapies in SCD.
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Affiliation(s)
- Lydian A de Ligt
- Amsterdam UMC location University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands
- Sanquin Research and Landsteiner Laboratory, Department of Molecular Hematology, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatric Hematology, Amsterdam, the Netherlands
| | - Aafke E Gaartman
- Amsterdam UMC location University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands
- Sanquin Research and Landsteiner Laboratory, Department of Molecular Hematology, Amsterdam, The Netherlands
| | - Bart J Biemond
- Amsterdam UMC location University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands
| | - Karin Fijnvandraat
- Sanquin Research and Landsteiner Laboratory, Department of Molecular Hematology, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam UMC location University of Amsterdam, Department of Pediatric Hematology, Amsterdam, the Netherlands
| | - Robin van Bruggen
- Sanquin Research and Landsteiner Laboratory, Department of Molecular Hematology, Amsterdam, The Netherlands
| | - Erfan Nur
- Amsterdam UMC location University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands
- Sanquin Research and Landsteiner Laboratory, Department of Molecular Hematology, Amsterdam, The Netherlands
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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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Alshehri MS, Alqahtani FS. Unusual presentation of tractional retinal detachment in beta thalassemia minor. Am J Ophthalmol Case Rep 2023; 32:101946. [PMID: 37942050 PMCID: PMC10630591 DOI: 10.1016/j.ajoc.2023.101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/01/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
Purpose To report a case of proliferative retinopathy with tractional retinal detachment associated with beta thalassemia minor in a 27-year-old female. Observations A young lady having beta thalassemia minor presented with decreased vision in both eyes, the effect being more severe in her right eye. The patient's other systemic history, including ophthalmic history, was unremarkable. The fundus examination revealed peripheral retinal ischemia in both eyes and tractional retinal detachment in the right eye. Conclusion Beta thalassemia minor is not associated with striking retinal pathology, nevertheless proliferative retinopathy. However, in this case the patient developed tractional retinal detachment that required surgery. This indicates that proliferative changes may develop in patients with beta thalassemia, and routine fundus examinations could be recommended for these patients.
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Serras-Pereira R, Vieira L, Saunders CJ, Maleita D, Figueiredo R, Anjos R, Marques M, Flores R. Identifying Clinical Predictors of Proliferative Sickle Cell Retinopathy. Curr Eye Res 2023; 48:1063-1067. [PMID: 37494145 DOI: 10.1080/02713683.2023.2242010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To identify systemic and/or ophthalmologic predictors of proliferative sickle retinopathy. METHODS Cross-sectional study comparing clinical, laboratory, and structural choriorretinal aspects between sickle cell disease patients with and without proliferative retinopathy. Patients underwent complete systemic and ophthalmologic evaluation. Enhanced depth spectral domain optical coherence tomography with choroidal binarization and optic coherence tomography angiography were performed and choriorretinal vascular components were compared. RESULTS Forty-five eyes from 45 sickle cell patients were included. Ninety-one percent of patients were diagnosed with sickle cell retinopathy, 29% with proliferative retinopathy. Mean corpuscular volume, lactate dehydrogenase, and percentage of fetal hemoglobin were reduced in the subgroup of patients with proliferative retinopathy when compared with patients without proliferative retinopathy (p ≤ 0.001; p = 0.04; p ≤ 0.001, respectively). The best predictor of proliferative retinopathy was mean corpuscular volume (AUC = 0.842; p = 0.001), followed by the percentage of fetal hemoglobin (AUC = 0.763, p = 0.009) and lactate dehydrogenase (AUC curve = 0.706; p = 0.039). No differences were found between groups in the quantitative analysis of retinal vascularization using OCTA and choroidal vascularization using OCT (p ≥ 0.05). CONCLUSION Fetal hemoglobin and mean corpuscular volume may be good predictors of proliferative sickle retinopathy. The association between proliferative retinopathy and reduced levels of lactate dehydrogenase and mean corpuscular volume points to hypoxia and not hemolysis as a possible driving force in its pathophysiology.
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Affiliation(s)
- Rita Serras-Pereira
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Luísa Vieira
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Christopher J Saunders
- Hematology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Diogo Maleita
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ricardo Figueiredo
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rita Anjos
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Marques
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rita Flores
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Comparison of Ultra-Wide Field Photography to Ultra-Wide Field Angiography for the Staging of Sickle Cell Retinopathy. J Clin Med 2022; 11:jcm11040936. [PMID: 35207207 PMCID: PMC8878037 DOI: 10.3390/jcm11040936] [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: 01/06/2022] [Revised: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 11/16/2022] Open
Abstract
Sickle cell retinopathy (SCR) is classified by Goldberg based on peripheral vascular changes. Ultra-wide field (UWF) imaging has enhanced visualization of the peripheral retina. However, there is no consensus on the optimal imaging technique for the screening of SCR. We performed a monocentric observational cross-sectional study to compare UWF fundus photography (UWF-FP) with UWF angiography (UWF-FA). All patients who underwent UWF-imaging (Optos, PLC, Scotland, UK) for screening of sickle cell retinopathy between January 2016 and December 2019 were retrospectively included. Eyes with previous laser treatment or concomitant retinal disease were excluded. UWF-FP images were graded based on the Goldberg classification by four graders with various degrees of experience. UWF-FA pictures were reviewed by an independent retina specialist. Differences in Goldberg staging across UWF-FP and UWF-FA were assessed. A total of 84 eyes of 44 patients were included. Based on UWF-FA, most eyes were stage 2 (77.4%) and 19 were stage 3 (22.6%). The pre-retinal neovascularization detection sensitivity on UWF-FP was 52.6 to 78.9%, depending on the graders. UWF-FA led to a later Goldberg stage of retinopathy, in most cases from stage 1 to stage 2. Neovascularization (stage 3) was not detected by our graders on UWF-FP in 21.1 to 57.9% of eyes. UWP-FP tends to underestimate Goldberg stages of retinopathy compared with UWF-FA and is less accurate when detecting neovascularization in sickle cell retinopathy, which has a direct impact on therapeutic management and prognosis.
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Abitbol E, Miere A, Excoffier JB, Mehanna CJ, Amoroso F, Kerr S, Ortala M, Souied EH. Deep learning-based classification of retinal vascular diseases using ultra-widefield colour fundus photographs. BMJ Open Ophthalmol 2022; 7:e000924. [PMID: 35141420 PMCID: PMC8819815 DOI: 10.1136/bmjophth-2021-000924] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/18/2022] [Indexed: 01/01/2023] Open
Abstract
Objective To assess the ability of a deep learning model to distinguish between diabetic retinopathy (DR), sickle cell retinopathy (SCR), retinal vein occlusions (RVOs) and healthy eyes using ultra-widefield colour fundus photography (UWF-CFP). Methods and Analysis In this retrospective study, UWF-CFP images of patients with retinal vascular disease (DR, RVO, and SCR) and healthy controls were included. The images were used to train a multilayer deep convolutional neural network to differentiate on UWF-CFP between different vascular diseases and healthy controls. A total of 224 UWF-CFP images were included, of which 169 images were of retinal vascular diseases and 55 were healthy controls. A cross-validation technique was used to ensure that every image from the dataset was tested once. Established augmentation techniques were applied to enhance performances, along with an Adam optimiser for training. The visualisation method was integrated gradient visualisation. Results The best performance of the model was obtained using 10 epochs, with an overall accuracy of 88.4%. For DR, the area under the receiver operating characteristics (ROC) curve (AUC) was 90.5% and the accuracy was 85.2%. For RVO, the AUC was 91.2% and the accuracy 88.4%. For SCR, the AUC was 96.7% and the accuracy 93.8%. For healthy controls, the ROC was 88.5% with an accuracy that reached 86.2%. Conclusion Deep learning algorithms can classify several retinal vascular diseases on UWF-CPF with good accuracy. This technology may be a useful tool for telemedicine and areas with a shortage of ophthalmic care.
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Affiliation(s)
- Elie Abitbol
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | - Alexandra Miere
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | | | - Carl-Joe Mehanna
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | - Francesca Amoroso
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | | | | | - Eric H Souied
- Department of Ophthalmology, Centre Hospitalier Intercommunal de Créteil, Creteil, France
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Fares S, Hajjar S, Romana M, Connes P, Acomat M, Zorobabel C, Zuber K, Boulanger-Scemama E, Etienne-Julan M, David T, Beral L. Sickle Cell Maculopathy: Microstructural Analysis Using OCTA and Identification of Genetic, Systemic, and Biological Risk Factors. Am J Ophthalmol 2021; 224:7-17. [PMID: 33412123 DOI: 10.1016/j.ajo.2020.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE To identify genetic, systemic, and biological factors associated with the occurrence of sickle cell maculopathy (SCM). To evaluate microvascular macular alterations using optical coherence tomography angiography (OCTA) in sickle cell disease (SCD). DESIGN Cross-sectional study. METHODS One hundred fifty-one eyes of 78 adult SCD patients (43 HbSS, 30 HbSC, 4 S/β+, and 1 HbS Lepore) and 40 eyes of 20 healthy controls underwent spectral-domain optical coherence tomography (SDOCT) and OCTA using Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany). We analyzed the occurrence of SCM, the foveal avascular zone (FAZ) area, and the severity of macular ischemia and studied their relationships with genetic, systemic, and biological parameters using multivariate logistic regression analysis. RESULTS Maculopathy occurred in 66 eyes (44%), and more frequently in HbSS patients (71%, P = .004). Multivariate analysis identified HbSS genotype and lower prothrombin ratio (PR) as independently associated with SCM (P = .01). Proliferative sickle cell retinopathy was also associated with SCM (P = .02). FAZ enlargement was associated with higher lactate dehydrogenase level (P = .02). Macular ischemia was more severe in patients with lower hemoglobin level (P = .004) and lower PR (P = .01). No flow areas were identified with OCTA even in eyes with no macular thinning (36 eyes, 42%) and appeared more frequently in the temporal superior subfield (36%). CONCLUSIONS HbSS genotype, abnormal coagulation and hemolysis increase the risk of SCM. OCTA provides valuable criteria to identify potential risk factors of SCM. OCTA also improves detection of early microvascular changes before the onset of macular thinning.
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Affiliation(s)
- Selim Fares
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France.
| | - Sophie Hajjar
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Marc Romana
- Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France; Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, Guadeloupe, France; Laboratoire d'Excellence GR-Ex, Paris, France
| | - Philippe Connes
- Laboratoire d'Excellence GR-Ex, Paris, France; Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard Lyon 1, Université de Lyon, France
| | - Malik Acomat
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Coralie Zorobabel
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Kevin Zuber
- Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Maryse Etienne-Julan
- Unité Transversale de la Drépanocytose, CHU de Pointe-à- Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | - Thierry David
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France; Université des Antilles, Guadeloupe (FWI), France
| | - Laurence Beral
- Service d'ophtalmologie, CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France; Université de Paris, UMR_S1134, BIGR, INSERM, Paris, France; Université des Antilles, UMR_S1134, BIGR, Pointe-à-Pitre, Guadeloupe, France; Université des Antilles, Guadeloupe (FWI), France
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Evaluation of Ocular Complications by Using Optical Coherence Tomography in Children With Sickle Cell Disease Eye Findings in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2020; 42:92-99. [PMID: 31851069 DOI: 10.1097/mph.0000000000001678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare optical coherence tomography (OCT) findings in pediatric patients with sickle cell disease (SCD) and healthy individuals and to investigate associations between these data and the patients' systemic findings. MATERIALS AND METHODS The study included 108 eyes of 54 patients with SCD with no visual symptoms and a control group consisting of 110 eyes of 55 healthy subjects with no systemic or ocular pathology. After best-corrected visual acuity assessment, the study participants underwent a complete ophthalmologic examination including intraocular pressure. After examination and pupil dilation induced with 1% tropicamide, 9×9 mm macular sections were obtained with spectral-domain OCT. The macular sections were evaluated according to Early Treatment Diabetic Retinopathy Study (ETDRS) map and internal and external retinal thicknesses were measured using the software included in the OCT device. RESULTS The patient group showed significantly more foveal flattening, temporal thinning, and vascular tortuosity than the control group (P<0.0001 for all). Foveal width was significantly greater in the patient group (1592.39±175.56 µm) compared with the control group (1391.01±175.56 µm) (P<0.0001), whereas foveal depth was significantly lower in the patient group (121.15±26.83 µm) than in the control group (146.1±12.25 µm) (P<0.0001). The mean total retinal thickness was 253.53±22.31 µm in the patient group and 261.03±18.48 µm in the control group (P=0.007). Similarly, central retinal thickness was significantly lower in the patient group (219.35±10.53 µm) compared with the control group (235.32±12.51 µm) (P<0.0001). DISCUSSION Our study shows that pediatric patients with SCD may have subclinical retinal involvement and that temporal thinning, in particular, is an important OCT finding. This strongly suggests that OCT imaging would be a beneficial addition to routine ophthalmologic examination in the diagnosis and follow-up of this patient group.
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[Sickle cell retinopathy in children: Report of 42 cases]. J Fr Ophtalmol 2020; 43:319-323. [PMID: 32093957 DOI: 10.1016/j.jfo.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 11/23/2022]
Abstract
We aimed to describe the epidemiological, etiological and clinical features, treatment and clinical course of sickle cell retinopathy in children and to determine the risk factors for serious involvement. METHODS This was a retrospective study including all children diagnosed with sickle cell retinopathy. Epidemiological, clinical and therapeutic characteristics, as well as clinical course, were analysed retrospectively by chart review. Two groups were defined: Group 1 (Goldberg stage 1 and 2); Group 2 (Goldberg stage 3, 4 and 5). In order to identify factors independently associated with severe sickle cell retinopathy, we conducted a logistic regression analysis in descending order. RESULTS The frequency of sickle cell retinopathy was 14.48%. Forty-two patients (84 eyes) were included; among them 23 boys and 19 girls, aged 10 to 17 with a mean age of 14±1.98 years. Twenty patients were of genotype SS, 11 patients of genotype SC, 8 Sβ and 3 SO Arab. The three patients in group 2 were all of SS genotype. The majority of patients (32) had an HbF level of less than 15%. All our patients had sickle cell retinopathy distributed as follows: 62% at stage 1; 31% at stage 2; 5% at stage 3 and 2% at stage 4. Multivariate analysis revealed a single risk factor independently linked to severe involvement - an HbF level<15%. CONCLUSION Retinopathy is a frequent complication of sickle cell disease which may lead to blindness. The HbF level is negatively correlated with severe involvement.
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Abstract
Background Wide-field imaging is a newer retinal imaging technology, capturing up to 200 degrees of the retina in a single photograph. Individuals with sickle cell retinopathy commonly exhibit peripheral retinal ischemia. Patients with proliferative sickle cell retinopathy develop pathologic retinal neovascularization of the peripheral retina which may progress into sight-threatening sequelae of vitreous hemorrhage and/or retinal detachment. The purpose of this review is to provide an overview of current and future applications of wide-field retinal imaging for sickle cell retinopathy, and recommend indications for best use. Main body There are several advantages to wide-field imaging in the clinical management of sickle cell disease patients. Retrospective and prospective studies support the success of wide-field imaging in detecting more sickle cell induced retinal microvascular abnormalities than traditional non-wide-field imaging. Clinicians can easily capture a greater extent of the retinal periphery in a patient's clinical baseline imaging to follow the changes at an earlier point and determine the rate of progression over time. Wide-field imaging minimizes patient and photographer burden, necessitating less photos and technical skill to capture the peripheral retina. Minimizing the number of necessary images can be especially helpful for pediatric patients with sickle cell retinopathy. Wide-field imaging has already been successful in identifying new biomarkers and risk factors for the development of proliferative sickle cell retinopathy. While these advantages should be considered, clinicians need to perform a careful risk-benefit analysis before ordering this test. Although wide-field fluorescein angiography successfully detects additional pathologic abnormalities compared to traditional imaging, a recent research study suggests that peripheral changes differentially detected by wide-field imaging may not change clinical management for most sickle cell patients. Conclusions While wide-field imaging may not carry a clinically significant direct benefit to all patients, it shows future promise in expanding our knowledge of sickle cell retinopathy. Clinicians may monitor peripheral retinal pathology such as retinal ischemia and retinal neovascularization over progressive time points, and use sequential wide-field retinal images to monitor response to treatment. Future applications for wide-field imaging may include providing data to facilitate machine learning, and potential use in tele-ophthalmology screening for proliferative sickle retinopathy.
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Affiliation(s)
- Marguerite O Linz
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 719, Baltimore, MD 21287 USA
| | - Adrienne W Scott
- Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Maumenee 719, Baltimore, MD 21287 USA
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Comparison between Adult Patients with Sickle Cell Disease of Sub-Saharan African Origin Born in Metropolitan France and in Sub-Saharan Africa. J Clin Med 2019; 8:jcm8122173. [PMID: 31835320 PMCID: PMC6947353 DOI: 10.3390/jcm8122173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023] Open
Abstract
Sickle cell disease (SCD) prevalence has increased rapidly in Europe as a result of an increase in the life expectancy of these patients and the arrival of SCD migrants from Africa. The aim of our study was to compare the phenotypes of adult patients born in Sub-Saharan Africa (SSA) who migrated to France with those of patients with the same origin who were born in France. This single-center observational study compared the demographic, clinical and biological characteristics of SCD adult patients of SSA origin who were born in France or SSA. Data were collected from computerized medical charts. Groups were compared using multivariate logistic regression with adjustment for age, gender and type of SCD. Of the 323 SCD patients followed in our center, 235 were enrolled, including 111 patients born in France and 124 patients born in SSA. SCD genotypes were balanced between groups. Patients born in Africa were older (median age 32.1 (24.4-39) vs. 25.6 (22.1-30.5) years, p < 0.001) and more often women (n = 75 (60.5%) vs. 48 (43.2%), p = 0.008). The median age at arrival in France was 18 years (13-23). The median height was lower among patients born in SSA (169 (163-175) vs. 174.5 cm (168-179), p < 0.001). Over their lifetimes, patients born in France had more acute chest syndromes (median number 2 (1-4) vs. 1 (0-3), p = 0.002), with the first episode occurring earlier (19 (11.6-22.3) vs. 24 (18.4-29.5) years, p < 0.007), and were admitted to intensive care units more often (53.3% vs. 34.9%, p = 0.006). This difference was more pronounced in the SS/Sβ0 population. Conversely, patients born in SSA had more skin ulcers (19.4% vs. 6.3%, p = 0.03). No significant differences were found in social and occupational insertion or other complications between the two groups. Patients born in SSA had a less severe disease phenotype regardless of their age than those born in France. This difference could be related to a survival bias occurring in Africa during childhood and migration to Europe that selected the least severe phenotypes.
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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: 25] [Impact Index Per Article: 5.0] [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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Mowatt L, Ajanaku A, Knight-Madden J. Knowledge, beliefs and practices regarding sickle cell eye disease of patients at the sickle cell unit, Jamaica. Pan Afr Med J 2019; 32:84. [PMID: 31223375 PMCID: PMC6560980 DOI: 10.11604/pamj.2019.32.84.14742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Sickle cell disease can result in visually threatening eye disease (proliferative sickle cell retinopathy). This can be prevented with timely eye screening. It is important for patients to understand their role. Our research is to determine the knowledge, beliefs and practices (KBP) regarding eye disease of Sickle Cell patients and the impact of genotype, demographic and socio-economic status. Methods Cross-sectional study at the Sickle Cell Unit, Jamaica during May 2016. Consecutive non-pregnant adults (>18 years of age) attendees, who were not acutely unwell, were invited to participate. A 26-item single interviewer administered questionnaire was used to obtain socio-demographic data, highest level of education completed, employment status, sickle cell genotype, if known, frequency of clinic attendance and patients' knowledge, beliefs and practices. Ten of these were yes/no questions, whereas eight required that they choose correct answers from four choices. Results One hundred subjects were recruited, 72% had homozygous SS disease. Their ages ranged from 18-63 years (mean 34.1 years, SD11.3). Fifty six percent were female. Most (75%) had achieved at least secondary education. The majority (62%) were unemployed. The mean belief score was 3.6/6(60%) and the mean knowledge and practice scores were 3.3/7(47%) and 2.2/5(44%) respectively. Milder genotypes had higher knowledge scores vs the more severe genotypes (4.0 vs 3.2, P=0.013). Only 28% had regular eye examinations; less than 50% had seen an ophthalmologist in the past year. Practice scores were higher in employed than in unemployed patients (2.6 vs 1.9, (P=0.04)). Employed patients were more likely than the unemployed to see their eye doctor for regular eye “examinations” (42.1% vs 19.4%, χ2=6.0, P=0.02). The practice and knowledge scores correlated (r2=0.363, P<0.001) and belief score (r2=0.304, P =0.002), except where 98% believed they should see an ophthalmologist annually, but only 42% did, and 21% had never. Conclusion Knowledge scores were fair, however, the practice was not always in keeping with knowledge.
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Affiliation(s)
- Lizette Mowatt
- Ophthalmology Division, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona, Jamaica.,Ophthalmology Division, University Hospital of the West Indies, Jamaica
| | - Ayodeji Ajanaku
- Russell Hall Hospital, The Dudley Group NHS Foundation Trust
| | - Jennifer Knight-Madden
- Sickle Cell Unit, Caribbean Institute for Health Research, University of the West Indies, Mona Campus Kingston 7, Jamaica
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Clinical and Ophthalmic Factors Associated With the Severity of Sickle Cell Retinopathy. Am J Ophthalmol 2019; 197:105-113. [PMID: 30278160 DOI: 10.1016/j.ajo.2018.09.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/08/2018] [Accepted: 09/25/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To identify associations between severity of sickle cell retinopathy (SCR) and other clinical, laboratory, or treatment factors relevant to sickle cell disease (SCD). DESIGN Retrospective cohort study. METHODS We investigated clinical, laboratory, and demographic associations with the severity of SCR in 296 patients seen at both our SCD specialty clinic and our retina clinic. Multivariate multinomial logistic regression was used to estimate the association between each clinical variable and severity of SCR. RESULTS Multivariate analysis showed that in patients with sickle cell anemia (SCA) genotypes, older age (95% confidence interval [CI], 1.04-1.15; P < .001) and male sex (95% CI, 0.13-0.87; P = .02) were associated with proliferative sickle cell retinopathy (PSR). In patients with genotypic variants, visual symptoms (95% CI, 1.36-21.62; P = .02) were associated with PSR. Laser photocoagulation and vitrectomy surgery, the standard interventions for PSR, were associated with older age (95% CI, 1.05-1.13; P < .001), visual symptoms (95% CI, 1.48-7.40; P = .004), higher hemoglobin level (95% CI, 1.14-1.65; P = .001), and no chronic transfusion (95% CI, 0.16-1.09; P = .08) across the whole cohort. CONCLUSIONS These findings may inform clinicians of the symptoms, systemic findings, and disease-modifying therapies most frequently associated with SCR in SCD patients. Visual symptoms such as blurred vision or floaters were associated with progression of SCR and may be criteria for referral for retinal examination. Chronic transfusion therapy may be protective against the need for retinal laser photocoagulation or vitrectomy. Prospective studies are necessary to further explore risk factors for SCR and to identify which individuals with SCD are at risk for incident or progression of retinopathy.
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Menaa F, Khan BA, Uzair B, Menaa A. Sickle cell retinopathy: improving care with a multidisciplinary approach. J Multidiscip Healthc 2017; 10:335-346. [PMID: 28919773 PMCID: PMC5587171 DOI: 10.2147/jmdh.s90630] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Sickle cell retinopathy (SCR) is the most representative ophthalmologic complication of sickle cell disease (SCD), a hemoglobinopathy affecting both adults and children. SCR presents a wide spectrum of manifestations and may even lead to irreversible vision loss if not properly diagnosed and treated at the earliest. Over the past decade, multidisciplinary research developments have focused upon systemic, genetic, and ocular risk factors of SCR, enabling the clinician to better diagnose and manage these patients. In addition, newer imaging and testing modalities, such as spectral domain-optical coherence tomography angiography, have resulted in the detection of subclinical retinopathy related to SCD. Innovative therapy includes intravitreal injection of an anti-vascular endothelial growth factor (eg, Lucentis® [ranibizumab] or Eylea® [aflibercept]) which appears comparatively safe and efficient, and may be combined with laser photocoagulation (LPC) for proliferative SCR. The effect of LPC alone does not significantly lead to the regression of advanced SCR, although it helps in avoiding hemorrhage and sight loss. This comprehensive article is based on 10-years retrospective (2007–2017) studies. It aims to present advances and recommendations in SCR theranostics while pointing out the requirement of combinatorial approaches for better management of SCR patients. To reach this goal, we identified and analyzed randomized original and review articles, clinical trials, non-randomized intervention studies, and observational studies using specified keywords in various databases (eg, Medline, Embase, Cochrane, ClinicalTrials.gov).
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Affiliation(s)
- Farid Menaa
- Department of Pharmaceutical Sciences and Nanomedicine, California Innovations Corporation, San Diego, CA, USA.,Departments of Clinical Medicine and Laser Therapy, Centre Médical des Guittières, Saint-Philbert-de-Grand-Lieu, Loire-Atlantique, France
| | - Barkat Ali Khan
- Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Bahawalpur
| | - Bushra Uzair
- Department of Bioinformatics and Biotechnology, International Islamic University, Islamabad, Pakistan
| | - Abder Menaa
- Departments of Clinical Medicine and Laser Therapy, Centre Médical des Guittières, Saint-Philbert-de-Grand-Lieu, Loire-Atlantique, France
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