Serras-Pereira Rita, Vieira Luísa, Saunders Christopher J, Maleita Diogo, Figueiredo Ricardo, Anjos Rita, Marques Margarida, Flores Rita
Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Hematology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
Curr Eye Res. 2023 Nov;48(11):1063-1067. doi: 10.1080/02713683.2023.2242010. Epub 2023 Jul 31.
To identify systemic and/or ophthalmologic predictors of proliferative sickle retinopathy.
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.
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 ( ≤ 0.001; = 0.04; ≤ 0.001, respectively). The best predictor of proliferative retinopathy was mean corpuscular volume (AUC = 0.842; = 0.001), followed by the percentage of fetal hemoglobin (AUC = 0.763, = 0.009) and lactate dehydrogenase (AUC curve = 0.706; = 0.039). No differences were found between groups in the quantitative analysis of retinal vascularization using OCTA and choroidal vascularization using OCT ( ≥ 0.05).
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.
确定增殖性镰状视网膜病变的全身和/或眼科预测指标。
横断面研究，比较患有和未患有增殖性视网膜病变的镰状细胞病患者的临床、实验室及脉络膜视网膜结构方面的情况。患者接受了全面的全身和眼科评估。进行了具有脉络膜二值化的增强深度谱域光学相干断层扫描和光学相干断层扫描血管造影，并比较了脉络膜视网膜血管成分。
纳入了45例镰状细胞病患者的45只眼。91%的患者被诊断为镰状细胞视网膜病变，29%为增殖性视网膜病变。与无增殖性视网膜病变的患者相比，增殖性视网膜病变患者亚组的平均红细胞体积、乳酸脱氢酶和胎儿血红蛋白百分比降低（分别为≤ 0.001；= 0.04；≤ 0.001）。增殖性视网膜病变的最佳预测指标是平均红细胞体积（AUC = 0.842；= 0.001），其次是胎儿血红蛋白百分比（AUC = 0.763，= 0.009）和乳酸脱氢酶（AUC曲线 = 0.706；= 0.039）。在使用OCTA对视网膜血管化进行定量分析以及使用OCT对脉络膜血管化进行定量分析时，两组之间未发现差异（≥ 0.05）。
胎儿血红蛋白和平均红细胞体积可能是增殖性镰状视网膜病变的良好预测指标。增殖性视网膜病变与乳酸脱氢酶和平均红细胞体积水平降低之间的关联表明缺氧而非溶血可能是其病理生理学的一个驱动因素。
