Intravitreal Ranibizumab for Stage IV Proliferative Sickle Cell Retinopathy: A First Case Report

Abstract

Purpose. To present the case of a 27-year-old male patient with stage IV proliferative sickle cell retinopathy, treated with one intravitreal injection of ranibizumab, showing regression of the neovascularization and no recurrence at the 9-month follow-up. Methods. A 27-year-old male patient presented with blurred vision and floaters in the right eye since three days. His best corrected visual acuity was 6/18. Ophthalmological examination and fluorescein angiography revealed proliferative sickle cell retinopathy stage IV with vitreous hemorrhage and sea fan neovascularization, as well as ischemic areas at the temporal periphery. Results. The patient was treated with one intravitreal injection of ranibizumab, presenting improvement in the visual acuity from 6/18 to 6/6, resolution of vitreous hemorrhage, and regression of the neovascularization. Additionally, he underwent scatter laser photocoagulation at the ischemic areas. At the 9-month follow-up there was no recurrence, while no adverse effects were noticed. Conclusions. Intravitreal ranibizumab may be a useful adjunct to laser photocoagulation in the management of proliferative sickle cell retinopathy and may permit some patients to avoid pars plana vitrectomy for vitreous hemorrhage.

Sickle cell retinopathy. A focused review

“…Current evidence is based on the use of bevacizumab with one exception describing the use of ranibizumab [68]. Similarly to proliferative diabetic retinopathy, intravitreal administration of bevacizumab therapy may lead to regression of neovascularization.…”

Sickle cell retinopathy: improving care with a multidisciplinary approach

“…Interestingly, in a first case report of PSCR, ranibizumab improved the visual acuity, resolution of VH, and regression of neovascularization with no recurrence or adverse effects. 79 Another FDA-approved drug Avastin ® (bevacizumab; Genentech, South San Francisco, CA, USA) is now restricted to the treatment of various types of cancer, hence its “off-label” use in ophthalmology. Bevacizumab, albeit efficient in preoperative injection, 80 was associated with significant secondary effects such as secondary hyphema few days postinjection in the eye of a PSCR patient with VH.…”

“… 43 It is then recommended that pan photocoagulation is preferentially realized with an argon arc beam, which should be well-placed at the ischemic areas, in order to avoid PPV in some PSCR eyes with VH. 79 Although SS-LPC to ischemic areas was reported to be effective after 6 months in achieving regression of peripheral neovascularization, 30 FV-LPC prevented occurrence of VH with lesser adverse effects. 43 , 86 In two randomized controlled trials comparing efficacy and safety of LPC to no therapy in children and adults with PSCR, 1) no difference in the complete PSCR regression was observed after an averaged follow-up period of 21–32 months when SS-LPC was compared to the control group; 2) SS-LPC or FV-LPC may prevent loss of vision in eyes with PSCR; 3) occurrence prevention of VH is possible either with argon or xenon laser but xenon arc was associated with a significantly higher risk of choroidal neovascularization; 4) FV-LPC displayed greater protective effects when compared to SS-LPC; 5) minimal adverse effects (ie, very low incidence of retinal tear, no induction of retinal detachment, vision loss was uncommon within at least 3 years of follow-up).…”

Gross anterior segment ischaemia following vitreoretinal surgery for sickle-cell retinopathy

“…A Cochrane review of only two studies demonstrated that the use of laser photocoagulation had no significant benefit when compared with conservative management in terms of disease regression or progression 7. Anti-vascular endothelial growth factor is an interesting option, although only a few case reports show it being used successfully 8–10. PPV appears to be the treatment of choice for retinal detachments, with a UK cohort study demonstrating good visual outcomes in seven patients undergoing retinal detachment surgery 6.…”