Macular Thickness in Iraqi patients with Sickle Cell Anemia View PDF

Khalid Tawfeeq Najm Alsayab
Department Of Ophthalmology, Al-Sayab Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq
^*Mokhles Jerri Meften Al-Sabti
Department Of Ophthalmology, Al-Sayab Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq

^*Corresponding Author:

Mokhles Jerri Meften Al-Sabti
Department Of Ophthalmology, Al-Sayab Teaching Hospital, Basrah Health Directorate, Ministry Of Health, Basrah, Iraq

Published on: 2024-11-27

Abstract

Introduction: Sickle cell disease (SCD) is the most common genetic disease in the world. Several authors have described morphological changes from the macula to optical coherence tomography-spectral domain (OCT SD) including the thinning of the predominant inner layers in the temporal area in SCD.

Methodology: This is an analytic study conducted mainly at the specialized ophthalmology department from March 2019 to July 2023.Any SCD patient who is 20 years of age or older were involved and sickle cell patients without retinal pathology (myopia, diabetic retinopathy and vitreo-retinal interface pathology). A full ophthalmologic examination was performed. The visual acuity was taken on the Snellen scale. The near vision acuity on the Parinaud scale. Refraction was done with the Nidek auto-refractometer. Measurement of intraocular pressure by the tonometer. The slit lamp examination of the anterior segment was done. The fundus was made using the Goldman 3-Mirror glass. Retinal thickness measurements were made using a Nidek RS-3000 Advance tomograph. The thickness was measured by the macula map early treatment diabetic retinopathy study [(ETDRS) (macula map)] made of 9 fields composed of 3 concentric circles of 1 mm, 3 mm, and 6 mm in diameter. The OCT test was interpretable when the signal strength index (SSI) was greater than or equal to 7/10.

Results: Here, the median age was 32 years. There is a predominance of female vs male sex ratio = 0.56. 84% of eyes had retinal lesions suggestive of non-prolifer ative retinopathy in the retina. The solar black spots were the most found retinal lesions (68%). Lesions were more localized temporally. In the OCT measurement, 60% of the eyes showed a decreased retinal thickness SD with 78% concerning the temporal retina. There was no decrease in visual acuity in our patients who had a decrease in retinal thickness at OCT SD.

Conclusion: There is a thinning of the retinal layers in sickle cell patients in the temporal region of the macula. Patients with retinal thinning are asymptomatic with preserved visual acuity.

Keywords

Sickle cells patients, Macular thickness, Optical coherence tomography, Retina, Retinopathy

Introduction

Sickle cell retinopathy (SCRP) occurs in more than half of patients [1, 2]. SCD is the commonest genetic disorder in the world [1]. Sever al authors have described morphological changes from the macula to OCT SD including the predominant inner layers thinning in the tem poral area. These modifications were found in asymptomatic cases [3].

T he WHO estimates that about 7% of the world’s population are carriers of hemoglobinopathies and about 300,000 to 400,000 babies are born every year with a severe form of hemoglobinopathy. Hemoglob inopathies are genetic disorders characterized by either abnormal he moglobin, as in SCD, or insufficient production of hemoglobin chains, as in thalassemia. Proliferative SCRP is the most serious vision-threat ening complication of SCD and is reportedly seen in 0.5 percent of patients with HbSS disease, the severe variant of SCD and about 2.5 percent of patients with HbSC disease, a less severe variant of SCD. The frequency of ocular involvement in patients with beta-thalassemia rang es from 41.3 to 85 percent, according to studies. This activity describes the causes, pathophysiology, and presentation of hemoglobinopathy-as sociated retinopathy and highlights the role of the inter-professional team in the care of affected patients. The ocular manifestations of SCD were described by Cook in 1930 when he noticed retinal hemorrhages in a patient who died of subarachnoid hemorrhage.

SCRP, especially proliferative sickle retinopathy, is considered the commonest cause of loss of vision in SCD. The best method to prevent the development of devastating complications of proliferative sickle retinopathy is regular dilated peripheral retinal examinations. Patients should be educated regarding the importance of regular ophthalmolog ical examinations. Patients should also be instructed to consult an oph thalmologist if they notice any changes in vision. Close follow-up and annual retinal examinations are also required in patients with thalas semia to prevent and detect any complications before permanent dam age occurs. Educating the patient will go a long way in this direction [4].

It seems therefore appropriate to assess the central thickness of the retina in SCD patients and to determine links with the clinical parameters.